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Individual

MISS AMANDA RAE BOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
3301 COLLEGE AVE, DAVIE, FL 33314-7721
(954) 262-8286
Mailing address
1600 NW 128TH DR APT 301, SUNRISE, FL 33323-5202
(661) 645-6811

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL5388
FL

Other

Enumeration date
10/17/2018
Last updated
10/17/2018
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