Provider Demographics
NPI:1518081165
Name:MYERS, AMANDA BETH (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:BETH
Last Name:MYERS
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PLAYERS CIR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3808
Mailing Address - Country:US
Mailing Address - Phone:732-264-8411
Mailing Address - Fax:
Practice Address - Street 1:419 MIDDLE RD
Practice Address - Street 2:RARITAN HIGH SCHOOL
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-2428
Practice Address - Country:US
Practice Address - Phone:732-264-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001039002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer