Healthcare Provider Details

I. General information

NPI: 1356792238
Provider Name (Legal Business Name): AMBER MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 08/16/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 SCHOOL ST
O FALLON MO
63366-2824
US

IV. Provider business mailing address

24 PALACE GREEN CT
O FALLON MO
63366-7547
US

V. Phone/Fax

Practice location:
  • Phone: 636-281-9815
  • Fax:
Mailing address:
  • Phone: 636-293-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2016003544
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: