Healthcare Provider Details

I. General information

NPI: 1700077559
Provider Name (Legal Business Name): AMY HELLEBUSCH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 WENTZVILLE PKWY
WENTZVILLE MO
63385-3407
US

IV. Provider business mailing address

4800 MEXICO RD SUITE 104
SAINT PETERS MO
63376-1666
US

V. Phone/Fax

Practice location:
  • Phone: 636-887-3660
  • Fax: 636-887-3661
Mailing address:
  • Phone: 636-928-4199
  • Fax: 636-922-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2001031547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: