Provider Demographics
NPI:1801238977
Name:ROBINSON, AMANDA LA'SHAE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LA'SHAE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 STADIUM DR W
Mailing Address - Street 2:ROOM D0107
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-0001
Mailing Address - Country:US
Mailing Address - Phone:850-228-9326
Mailing Address - Fax:850-645-1915
Practice Address - Street 1:425 STADIUM DR W
Practice Address - Street 2:ROOM D0107
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-0001
Practice Address - Country:US
Practice Address - Phone:850-228-9326
Practice Address - Fax:850-645-1915
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL32852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer