Healthcare Provider Details

I. General information

NPI: 1730189457
Provider Name (Legal Business Name): AMANDA DYAN GRINDEL P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA DYAN DEPRIEST

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8516 N OAK TRFY
KANSAS CITY MO
64155-2433
US

IV. Provider business mailing address

8516 N OAK TRFY
KANSAS CITY MO
64155-2433
US

V. Phone/Fax

Practice location:
  • Phone: 816-436-4500
  • Fax: 816-436-4510
Mailing address:
  • Phone: 816-436-4500
  • Fax: 816-436-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01647
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2002003114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: