Healthcare Provider Details

I. General information

NPI: 1114392487
Provider Name (Legal Business Name): AMANDA KING ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 UNIVERSITY BLVD
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

1509 BOATRIGHT DR NE
ALBUQUERQUE NM
87112-3829
US

V. Phone/Fax

Practice location:
  • Phone: 925-813-8251
  • Fax:
Mailing address:
  • Phone: 925-813-8251
  • 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: