Provider Demographics
NPI:1770029233
Name:CAGLE, AMANDA JOYCE (MS, ATC-LAT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOYCE
Last Name:CAGLE
Suffix:
Gender:F
Credentials:MS, ATC-LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SEVIERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5108
Mailing Address - Country:US
Mailing Address - Phone:865-238-6090
Mailing Address - Fax:
Practice Address - Street 1:1410 SEVIERVILLE RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5108
Practice Address - Country:US
Practice Address - Phone:865-238-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer