Provider Demographics
NPI:1881846590
Name:FITZHUGH, AMELIA NICOLE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:NICOLE
Last Name:FITZHUGH
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 TRIMMER TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3396
Mailing Address - Country:US
Mailing Address - Phone:513-310-1704
Mailing Address - Fax:
Practice Address - Street 1:30 WASHINGTON AVE
Practice Address - Street 2:WASHINGTON AND LEE UNIVERSITY
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450
Practice Address - Country:US
Practice Address - Phone:540-458-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
050702128OtherBOC CERTIFICATION