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General NPI Number Information
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NPI Number | 1922574995
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Entity Type | Individual
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Provider Name | AMANDA RAE BOCK ATC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 3301 COLLEGE AVE
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City | DAVIE
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State | FL
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Zip | 33314-7721
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Country | US
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Telephone | 954-262-8286
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 NW 128TH DR APT 301
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City | SUNRISE
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State | FL
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Zip | 33323-5202
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Country | US
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Telephone | 661-645-6811
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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 | AL5388
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License Number State | FL
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