Provider Demographics
NPI:1346690500
Name:JANUCHOWSKI, AMANDA (ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:JANUCHOWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 HORTON FIELD HOUSE
Mailing Address - Street 2:CAMPUS BOX 7130
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-7130
Mailing Address - Country:US
Mailing Address - Phone:309-438-3340
Mailing Address - Fax:309-438-2131
Practice Address - Street 1:110 HORTON FIELD HOUSE
Practice Address - Street 2:CAMPUS BOX 7130
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-7130
Practice Address - Country:US
Practice Address - Phone:309-438-3340
Practice Address - Fax:309-438-2131
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer