Provider Demographics
NPI:1871036558
Name:BARGENDER, AMANDA JEAN (ATC, LAT, OTC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:BARGENDER
Suffix:
Gender:F
Credentials:ATC, LAT, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9701
Mailing Address - Country:US
Mailing Address - Phone:715-370-6035
Mailing Address - Fax:
Practice Address - Street 1:1446 1ST AVE
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9470
Practice Address - Country:US
Practice Address - Phone:715-358-0610
Practice Address - Fax:608-785-8674
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2269-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer