Provider Demographics
NPI:1083474399
Name:TAYLOR, AMANI MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:AMANI
Middle Name:MICHELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 GRASSO PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3107
Mailing Address - Country:US
Mailing Address - Phone:314-940-7814
Mailing Address - Fax:314-798-6688
Practice Address - Street 1:83 GRASSO PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-3107
Practice Address - Country:US
Practice Address - Phone:314-940-7814
Practice Address - Fax:314-798-6688
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028853225100000X
MO2024006187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist