Provider Demographics
NPI:1770936205
Name:BRENDEMUEHL, AMANDA (MS, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:BRENDEMUEHL
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 MANDARIN WAY
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6314
Mailing Address - Country:US
Mailing Address - Phone:507-339-3629
Mailing Address - Fax:
Practice Address - Street 1:1027 MANDARIN WAY
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6314
Practice Address - Country:US
Practice Address - Phone:507-339-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 26132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer