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General NPI Number Information
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NPI Number | 1588523211
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Entity Type | Individual
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Provider Name | AMULYA SETHUMADHAVAN
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Gender | Female
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 7068 S OUTER 364
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City | O FALLON
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State | MO
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Zip | 63368-7757
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Country | US
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Telephone | 479-372-3882
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Fax |
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Provider Business Mailing Address
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Address Line | 131 GUNSTON HALL DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-1048
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Country | US
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Telephone | 479-372-3882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2025047004
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License Number State | MO
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