Healthcare Provider Details

I. General information

NPI: 1720694607
Provider Name (Legal Business Name): REBECCA AMMANN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 DOUGHERTY FERRY RD STE 104
SAINT LOUIS MO
63122-3372
US

IV. Provider business mailing address

2705 DOUGHERTY FERRY RD STE 104
SAINT LOUIS MO
63122-3372
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-3319
  • Fax:
Mailing address:
  • Phone: 314-394-3319
  • Fax: 314-394-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2014030412
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2018028529
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: