Individual provider Active NPI

Amanda Madeline Crittenden, ATC

  • Athletic Trainer
  • Stafford, VA
National Provider Identifier
1174867725
Registry record updated Nov 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
0126001949 Issued in VA
Practice address
2777 Jefferson Davis Hwy
Suite 109
Stafford, VA 22554-8323
Phone
(540) 318-8615
NPI assigned
Nov 20, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 0126001949 VA Primary

Addresses

Primary practice location

2777 Jefferson Davis Hwy
Suite 109
Stafford, VA 22554-8323

Mailing address

4 Timothy LN
Stafford, VA 22556-1241
Phone (540) 907-9445

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

State licenses

LicenseStateTypeSpecialty
0126001949VAMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Physical Therapy of Stafford, LLC PastSince Feb 1, 2014 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353369600000",
    "number": "1174867725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 TIMOTHY LN",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225561241",
            "telephone_number": "540-907-9445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 JEFFERSON DAVIS HWY",
            "address_2": "SUITE 109",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225548323",
            "telephone_number": "540-318-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRITTENDEN",
        "first_name": "AMANDA",
        "middle_name": "MADELINE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-20",
        "last_updated": "2012-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126001949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.