Provider Demographics
NPI:1265232284
Name:TERRANOVA, BRENDAN WILLIAM (NASM CPT, CES, CNC)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:WILLIAM
Last Name:TERRANOVA
Suffix:
Gender:M
Credentials:NASM CPT, CES, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 BRODIE LN STE 160
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5892
Mailing Address - Country:US
Mailing Address - Phone:615-482-5537
Mailing Address - Fax:615-482-5537
Practice Address - Street 1:9901 BRODIE LN STE 160
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5892
Practice Address - Country:US
Practice Address - Phone:615-482-5537
Practice Address - Fax:615-482-5537
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12310419652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty