Provider Demographics
NPI:1346986866
Name:PEREZ, AMANDA CHRISTINE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:ZACHARKOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:371 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-4689
Practice Address - Country:US
Practice Address - Phone:609-522-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001600002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer