MEDICARE: AMANDA DYAN GRINDEL P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	14-01647	KS
2	225200000X	Physical Therapy Assistant	2002003114	MO

General Provider Information

NPI Number	:	1730189457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DYAN GRINDEL P.T.A.

Provider Business Mailing Address
First Line	:	8516 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2433
Country	:	US
Telephone Number	:	816-436-4500
Fax Number	:	816-436-4510

Provider Business Practice Location Address
First Line	:	8516 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2433
Country	:	US
Telephone Number	:	816-436-4500
Fax Number	:	816-436-4510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/26/2008

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