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Individual

MISS AMANDA MARIE LARUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC, LAT

Contact information

Practice address
800 UNIVERSITY DR, LAMKIN ACTIVITY CENTER, MARYVILLE, MO 64468-6015
(660) 562-1664
Mailing address
1212 FOX RD APT 8, MARYVILLE, MO 64468-3356
(214) 293-5834

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
01/26/2007
Last updated
07/08/2007
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