Basic Information
| Provider Information | |||||||||
| NPI: | 1558701482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINKLER | ||||||||
| FirstName: | AMANDA | ||||||||
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| OtherLastName: | FRICK | ||||||||
| OtherFirstName: | AMANDA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1034 S BRENTWOOD BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171223 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1034 S BRENTWOOD BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146441978 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2013018609 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.