MEDICARE: MRS. AMANDA J CARTER MSPT ATC CMPT CWC

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	225100000X	Physical Therapist	070012900	IL
2	225100000X	Physical Therapist	2002004499	MO

General Provider Information

NPI Number	:	1770693855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA J CARTER MSPT ATC CMPT CWC

Provider Business Mailing Address
First Line	:	8855 BRACKEN CIR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-1110
Country	:	US
Telephone Number	:	314-440-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 UNION RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1064
Country	:	US
Telephone Number	:	314-274-9222
Fax Number	:	314-200-9609

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/10/2020

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