Provider Demographics
NPI:1891289971
Name:DUNENS, AMANDA BEAL (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BEAL
Last Name:DUNENS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BEAL
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:2156 BOYD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3522
Mailing Address - Country:US
Mailing Address - Phone:713-304-1162
Mailing Address - Fax:
Practice Address - Street 1:2500 CAMPUS BOX # 104
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-2005
Practice Address - Country:US
Practice Address - Phone:336-278-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer