Provider Demographics
NPI:1962795161
Name:ESTOPARE, AMY KATHLEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:ESTOPARE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KATHLEEN
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:17134 BEL RAY PL
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5331
Practice Address - Country:US
Practice Address - Phone:816-318-0436
Practice Address - Fax:816-318-0437
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04363225100000X
MO2011021975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
45793021OtherBCBS KC
MOMA4370004OtherMEDICARE PTAN
KSKA2868033OtherMEDICARE PTAN