Healthcare Provider Details

I. General information

NPI: 1063612794
Provider Name (Legal Business Name): AMANDA JEAN HILL MS, ATC, PES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 OAK RD #122
WALNUT CREEK CA
94597-7708
US

IV. Provider business mailing address

1792 E RYAN LN
FRESNO CA
93720-4058
US

V. Phone/Fax

Practice location:
  • Phone: 559-259-1944
  • Fax:
Mailing address:
  • Phone: 559-273-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: