Provider Demographics
NPI:1942951975
Name:ADAMS, AMANDA JO (LAT/ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 W BLACK CREEK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-8720
Mailing Address - Country:US
Mailing Address - Phone:765-230-7690
Mailing Address - Fax:
Practice Address - Street 1:2017 W BLACK CREEK VALLEY RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-8720
Practice Address - Country:US
Practice Address - Phone:765-230-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001309A2083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine