Provider Demographics
NPI:1457927527
Name:PANKRATZ, AMANDA C (ATC, LAT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:PANKRATZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14420 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-8054
Mailing Address - Country:US
Mailing Address - Phone:913-991-2172
Mailing Address - Fax:
Practice Address - Street 1:11501 W 81ST ST APT 338
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-3319
Practice Address - Country:US
Practice Address - Phone:913-991-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9642255A2300X
MO20210307072255A2300X
KS24-014692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000034545OtherBOARD CERTIFICATION NUMBER
104104OtherNATA- CERTIFIED MEMBER