Provider Demographics
NPI:1164281853
Name:FLEER, AMBER (PT, ATC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FLEER
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 N FARM ROAD 117
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-7222
Mailing Address - Country:US
Mailing Address - Phone:417-861-3219
Mailing Address - Fax:
Practice Address - Street 1:304 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9472
Practice Address - Country:US
Practice Address - Phone:417-457-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001486262255A2300X
MO2002004503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer