Provider Demographics
NPI:1912550203
Name:MANG, AMANDA CLAIRE (MS, ATC, LAT, CEAS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CLAIRE
Last Name:MANG
Suffix:
Gender:F
Credentials:MS, ATC, LAT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1749
Mailing Address - Country:US
Mailing Address - Phone:219-765-3320
Mailing Address - Fax:
Practice Address - Street 1:720 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1398
Practice Address - Country:US
Practice Address - Phone:812-663-1111
Practice Address - Fax:812-663-1324
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001531A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer