Provider Demographics
NPI:1891076675
Name:BEADLE, AMANDA KAY (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KAY
Last Name:BEADLE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 10TH AVE APT A7
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3944
Mailing Address - Country:US
Mailing Address - Phone:316-617-6706
Mailing Address - Fax:620-229-6380
Practice Address - Street 1:100 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2443
Practice Address - Country:US
Practice Address - Phone:620-229-6375
Practice Address - Fax:620-229-6380
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer