Provider Demographics
NPI:1952503351
Name:FRANK, AMANDA RENE' (ATC)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:RENE'
Last Name:FRANK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16114 CHALLIS ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1431
Mailing Address - Country:US
Mailing Address - Phone:562-477-2322
Mailing Address - Fax:
Practice Address - Street 1:5772 BOLSA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1134
Practice Address - Country:US
Practice Address - Phone:714-897-3589
Practice Address - Fax:714-897-1316
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer