Provider Demographics
NPI:1174867725
Name:CRITTENDEN, AMANDA MADELINE (ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MADELINE
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1241
Mailing Address - Country:US
Mailing Address - Phone:540-907-9445
Mailing Address - Fax:
Practice Address - Street 1:2777 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8323
Practice Address - Country:US
Practice Address - Phone:540-318-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260019492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer