Healthcare Provider Details

I. General information

NPI: 1093921082
Provider Name (Legal Business Name): AMANDA HEPPERMANN A.T.C., P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PIPER HILL DR STE 160
SAINT PETERS MO
63376-1651
US

IV. Provider business mailing address

1 KING EDWARD CT
O FALLON MO
63366-7909
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-7065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number116752
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: