Healthcare Provider Details

I. General information

NPI: 1659284875
Provider Name (Legal Business Name): AMANDA N WEYAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BRIM ST
DESLOGE MO
63601-3441
US

IV. Provider business mailing address

722 BLUE ST
BONNE TERRE MO
63628-1902
US

V. Phone/Fax

Practice location:
  • Phone: 573-944-4382
  • Fax:
Mailing address:
  • Phone: 573-944-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2015002007
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: