Healthcare Provider Details

I. General information

NPI: 1356457386
Provider Name (Legal Business Name): RACHEL MARIE AMADIO ATC, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N RICHMOND ST
FLEETWOOD PA
19522-1058
US

IV. Provider business mailing address

4234 6TH AVE
TEMPLE PA
19560-1714
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-7626
  • Fax:
Mailing address:
  • Phone: 610-929-4178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003499
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: