Basic Information
| Provider Information | |||||||||
| NPI: | 1730189457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRINDEL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | DYAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | P.T.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEPRIEST | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | DYAN | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8516 N OAK TRFY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641552433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164364500 | ||||||||
| FaxNumber: | 8164364510 | ||||||||
| Practice Location | |||||||||
| Address1: | 8516 N OAK TRFY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641552433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164364500 | ||||||||
| FaxNumber: | 8164364510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 11/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 14-01647 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2002003114 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.