Provider Demographics
NPI:1932960333
Name:RATHBUN, AMANDA J (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROSE HILL CT
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-6601
Mailing Address - Country:US
Mailing Address - Phone:903-810-1077
Mailing Address - Fax:
Practice Address - Street 1:1806 AVENUE J
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6601
Practice Address - Country:US
Practice Address - Phone:903-810-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT71672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer