Healthcare Provider Details

I. General information

NPI: 1750491346
Provider Name (Legal Business Name): AMANDA K ROSENKRANS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3652 STARDUST DR
HANNIBAL MO
63401-6212
US

IV. Provider business mailing address

3652 STARDUST DR
HANNIBAL MO
63401-6212
US

V. Phone/Fax

Practice location:
  • Phone: 573-221-8800
  • Fax:
Mailing address:
  • Phone: 573-221-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005031148
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: