Provider Demographics
NPI:1053921239
Name:DURST, AMELIA (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:DURST
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 STONO LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2112
Mailing Address - Country:US
Mailing Address - Phone:530-409-6220
Mailing Address - Fax:
Practice Address - Street 1:707 STONO LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2112
Practice Address - Country:US
Practice Address - Phone:530-409-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty