Healthcare Provider Details

I. General information

NPI: 1124532098
Provider Name (Legal Business Name): AMANDA BARBEE MED, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8779 GREENLEAVES DR
DENHAM SPRINGS LA
70726-6747
US

IV. Provider business mailing address

13103 SOUTHERN VALLEY DR
PEARLAND TX
77584-3793
US

V. Phone/Fax

Practice location:
  • Phone: 504-296-4296
  • Fax:
Mailing address:
  • Phone: 504-296-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT5149
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number312933
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: