Provider Demographics
NPI:1982011466
Name:TAYLOR, AMANDA RENEE (ATC, SCATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC, SCATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GEORGE ST
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29424-0001
Mailing Address - Country:US
Mailing Address - Phone:834-953-6540
Mailing Address - Fax:
Practice Address - Street 1:66 GEORGE ST
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29424-0001
Practice Address - Country:US
Practice Address - Phone:834-953-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20000034692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer