Provider Demographics
NPI:1073832184
Name:WANG, AMANDA D (DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:D
Last Name:WANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LEVINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 JUNGERMAN CR STE 304
Mailing Address - Street 2:
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6726 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3525
Practice Address - Country:US
Practice Address - Phone:314-647-0081
Practice Address - Fax:314-647-5485
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist