Provider Demographics
NPI:1427491380
Name:FLETCHER, AMANDA (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 S FEDERAL HWY
Mailing Address - Street 2:106
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1245
Mailing Address - Country:US
Mailing Address - Phone:954-522-3355
Mailing Address - Fax:954-522-9590
Practice Address - Street 1:789 S FEDERAL HWY
Practice Address - Street 2:106
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1245
Practice Address - Country:US
Practice Address - Phone:954-522-3355
Practice Address - Fax:954-522-9590
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL26962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer