Provider Demographics
NPI:1467654095
Name:GLENDENNING, AMANDA CAROL (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CAROL
Last Name:GLENDENNING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVERFRONT TRL
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-8652
Mailing Address - Country:US
Mailing Address - Phone:417-533-7390
Mailing Address - Fax:
Practice Address - Street 1:331 HOSPITAL DR STE D
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9251
Practice Address - Country:US
Practice Address - Phone:417-533-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist