Provider Demographics
NPI:1396116802
Name:MARTIN, AMANDA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-8348
Mailing Address - Country:US
Mailing Address - Phone:937-728-5749
Mailing Address - Fax:
Practice Address - Street 1:215 MAYNARD LAKE RD
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-8507
Practice Address - Country:US
Practice Address - Phone:937-728-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program