Healthcare Provider Details

I. General information

NPI: 1073953949
Provider Name (Legal Business Name): AMANDA R HUNT RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CORONA RD SUITE 301
COLUMBIA MO
65203-2548
US

IV. Provider business mailing address

RR 82 BOX 302A2
FLEMINGTON MO
65650-9661
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-3860
  • Fax:
Mailing address:
  • Phone: 417-282-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2003025344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: