Provider Demographics
NPI:1437459567
Name:JOHNSON, AMANDA JO (MPT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 EAST HWY 72
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7491
Mailing Address - Country:US
Mailing Address - Phone:573-783-8001
Mailing Address - Fax:573-783-6717
Practice Address - Street 1:805 EAST HWY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7491
Practice Address - Country:US
Practice Address - Phone:573-783-8001
Practice Address - Fax:573-783-6717
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009034591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist