Provider Demographics
NPI:1548660707
Name:STOWAY, AMANDA DAWN (CPTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DAWN
Last Name:STOWAY
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13041
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66113-0041
Mailing Address - Country:US
Mailing Address - Phone:913-731-9342
Mailing Address - Fax:
Practice Address - Street 1:10000 W 75TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2209
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:877-913-1174
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant