Provider Demographics
NPI:1093258493
Name:MARCHINO, AMANDA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MARCHINO
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BRAKKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7024 PLUM DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-8001
Mailing Address - Country:US
Mailing Address - Phone:515-650-7520
Mailing Address - Fax:
Practice Address - Street 1:450 LAUREL ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3045
Practice Address - Country:US
Practice Address - Phone:515-343-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000896171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor