Basic Information
| Provider Information | |||||||||
| NPI: | 1447923743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONSIVAES | ||||||||
| FirstName: | AMADA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | AT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 517 MECHANIC ST | ||||||||
| Address2: | |||||||||
| City: | THREE RIVERS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490931635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696258197 | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 TURWILL LN | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490064231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693438170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2021 | ||||||||
| LastUpdateDate: | 08/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2601002624 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.