Healthcare Provider Details

I. General information

NPI: 1487872503
Provider Name (Legal Business Name): AMY RUTH HUFFSTUTLAR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 HEARTLAND RD
SAINT JOSEPH MO
64506-3492
US

IV. Provider business mailing address

15200 43RD SERVICE RD SE
FAUCETT MO
64448-7180
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-8506
  • Fax:
Mailing address:
  • Phone: 816-238-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2001001471
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: