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General NPI Number Information
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NPI Number | 1679088520
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Entity Type | Individual
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Provider Name | AMANDA E HENRICHS DPT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 1915 CARLYLE AVE STE D
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City | BELLEVILLE
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State | IL
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Zip | 62221-4578
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Country | US
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Telephone | 618-310-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-1980
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Fax | 630-928-5080
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070024687
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License Number State | IL
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