Provider Demographics
NPI:1801860556
Name:CARDONA, AMY C (ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:CARDONA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:CHURCHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:3316 HORNSEA RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-2804
Mailing Address - Country:US
Mailing Address - Phone:757-271-1545
Mailing Address - Fax:
Practice Address - Street 1:3316 HORNSEA RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-2804
Practice Address - Country:US
Practice Address - Phone:757-271-1545
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260002782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer