Provider Demographics
NPI:1376943787
Name:ADAMS, AMANDA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ADAMS
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 1:4026 SENOUR RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9344
Mailing Address - Country:US
Mailing Address - Phone:317-354-5049
Mailing Address - Fax:
Practice Address - Street 1:4401 W 52ND ST
Practice Address - Street 2:#603
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1701
Practice Address - Country:US
Practice Address - Phone:317-387-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002246A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer