Provider Demographics
NPI:1164831582
Name:HARBAUGH, AMANDA (ATC/LAT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HARBAUGH
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 9TH ST
Mailing Address - Street 2:APT. B
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1242
Mailing Address - Country:US
Mailing Address - Phone:417-872-8053
Mailing Address - Fax:
Practice Address - Street 1:700 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1436
Practice Address - Country:US
Practice Address - Phone:417-236-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110244292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer