Healthcare Provider Details

I. General information

NPI: 1922554443
Provider Name (Legal Business Name): AMANDA CARTER MS, ATC, VATL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 INDEPENDENCE AVE
BEALETON VA
22712-6843
US

IV. Provider business mailing address

6300 INDEPENDENCE AVE
BEALETON VA
22712-6843
US

V. Phone/Fax

Practice location:
  • Phone: 540-422-7360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000004231
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: