Provider Demographics
NPI:1053824441
Name:AMANN, MARYBRIDGET (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARYBRIDGET
Middle Name:
Last Name:AMANN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14855 N OUTER 40 RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2026
Mailing Address - Country:US
Mailing Address - Phone:636-532-0150
Mailing Address - Fax:636-532-8192
Practice Address - Street 1:14855 N OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2026
Practice Address - Country:US
Practice Address - Phone:636-532-0150
Practice Address - Fax:636-532-8192
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115299225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant