MEDICARE: MRS. AMY L VACEK MPT, CERT. MDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2001005033	MO

General Provider Information

NPI Number	:	1679800353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY L VACEK MPT, CERT. MDT

Provider Business Mailing Address
First Line	:	722 N HIGHWAY 47 STE A
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-1108
Country	:	US
Telephone Number	:	636-456-8883
Fax Number	:	636-456-8854

Provider Business Practice Location Address
First Line	:	722 N HIGHWAY 47 STE A
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-1108
Country	:	US
Telephone Number	:	636-456-8883
Fax Number	:	636-456-8854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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