Provider Demographics
NPI:1750491346
Name:ROSENKRANS, AMANDA K (PT)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:K
Last Name:ROSENKRANS
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 1:3652 STARDUST DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6212
Mailing Address - Country:US
Mailing Address - Phone:573-221-8800
Mailing Address - Fax:
Practice Address - Street 1:3652 STARDUST DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6212
Practice Address - Country:US
Practice Address - Phone:573-221-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220781802Medicare ID - Type UnspecifiedCMS PROV.#