Healthcare Provider Details

I. General information

NPI: 1780549980
Provider Name (Legal Business Name): AMY KANG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4044 BUTLER HILL RD
SAINT LOUIS MO
63129-1500
US

IV. Provider business mailing address

14515 N OUTER 40 RD STE 110
CHESTERFIELD MO
63017-5746
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-6644
  • Fax:
Mailing address:
  • Phone: 314-434-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2025052808
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: