Provider Demographics
NPI:1700077559
Name:HELLEBUSCH, AMY (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HELLEBUSCH
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 1:4800 MEXICO RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:636-928-4199
Mailing Address - Fax:636-922-0818
Practice Address - Street 1:1425 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3407
Practice Address - Country:US
Practice Address - Phone:636-887-3660
Practice Address - Fax:636-887-3661
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO180200003Medicare UPIN