Provider Demographics
NPI:1255400503
Name:WASTLER, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WASTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1630
Mailing Address - Country:US
Mailing Address - Phone:913-432-7376
Mailing Address - Fax:
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 150
Practice Address - Street 2:
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3268
Practice Address - Country:US
Practice Address - Phone:816-421-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005017284OtherLICENSE#