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General NPI Number Information
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NPI Number | 1548854581
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Entity Type | Individual
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Provider Name | AMBER HEATH DAT, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 02/20/2021
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Last Update Date | 02/20/2021
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Provider Practice Location Address
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Address Line | 303 UNIVERSITY AVE
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City | NEWARK
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State | NJ
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Zip | 07102-1798
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Country | US
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Telephone | 975-877-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HOFFMAN BLVD APT 3C
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1555
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Country | US
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Telephone | 757-618-1113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003096
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00234700
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License Number State | NJ
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