Active NPI
Amanda Prusak, MA, ATC, LAT
- Athletic Trainer
- Tuscaloosa, AL
National Provider Identifier
1144642158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2310
- Practice address
- 1800 McFarland Blvd E Ste 340
Tuscaloosa, AL 35404-5882 - Phone
- (205) 345-2801
- NPI assigned
- Jan 9, 2014
- Last updated
- Apr 5, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2310 | NC | Primary |
Addresses
Primary practice location
1800 McFarland Blvd E Ste 340
Tuscaloosa, AL 35404-5882
Mailing address
1800 McFarland Blvd E Ste 340
Tuscaloosa, AL 35404-5882
Phone (717) 309-4662
Other practice location 1
530 Rivers St
Boone, NC 28608-0001
Phone (717) 309-4662
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2310 | Other | NC | NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS |
| 200014240 | Other | BOARD OF CERTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2310 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554422400000",
"number": "1144642158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 MCFARLAND BLVD E STE 340",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354045882",
"telephone_number": "717-309-4662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 MCFARLAND BLVD E STE 340",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354045882",
"telephone_number": "205-345-2801"
}
],
"practiceLocations": [
{
"address_1": "530 Rivers St",
"address_purpose": "LOCATION",
"city": "Boone",
"state": "NC",
"postal_code": "286080001",
"country_code": "US",
"telephone_number": "717-309-4662",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PRUSAK",
"first_name": "AMANDA",
"credential": "MA, ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-09",
"last_updated": "2019-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "2310",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS",
"identifier": "2310",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF CERTIFICATION",
"identifier": "200014240",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tuscaloosa, AL
- James Bradley Proctor, M.D.
- Professional Therapy Services Inc
- Progressive Environments for Tuscaloosa Residents Alliance, Inc
- Mark Linden Prohaska, PH.D.
- Tempest Lucindra Prude, FNP-C
- Psychiatric Corporation of Alabama
- Psychiatry South, Inc.
- Publix Alabama LLC (Publix Pharmacy #0075)
- Publix Alabama LLC (Publix Pharmacy #1253)
- Velda D. Pugh, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.