Provider Demographics
NPI:1831594738
Name:VAKERICS, AMANDA (MS, ATC, AT/L)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VAKERICS
Suffix:
Gender:F
Credentials:MS, ATC, AT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3844 33RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2514
Mailing Address - Country:US
Mailing Address - Phone:734-812-8487
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1604174992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000008001OtherBOARD OF CERTIFICATION, INC.
WAA160417499OtherWASHINGTON STATE DEPARTMENT OF HEALTH, ATHLETIC TRAINER LICENSE