Provider Demographics
NPI:1730189457
Name:GRINDEL, AMANDA DYAN (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DYAN
Last Name:GRINDEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DYAN
Other - Last Name:DEPRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8516 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2433
Mailing Address - Country:US
Mailing Address - Phone:816-436-4500
Mailing Address - Fax:816-436-4510
Practice Address - Street 1:8516 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2433
Practice Address - Country:US
Practice Address - Phone:816-436-4500
Practice Address - Fax:816-436-4510
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01647225200000X
MO2002003114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant