Provider Demographics
NPI:1871881151
Name:FISHER, AMANDA LYNN (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:MENNEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:668 SE BAYBERRY LN
Mailing Address - Street 2:STE 105
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4366
Mailing Address - Country:US
Mailing Address - Phone:816-607-1406
Mailing Address - Fax:816-286-4112
Practice Address - Street 1:668 SE BAYBERRY LN
Practice Address - Street 2:STE 105
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4366
Practice Address - Country:US
Practice Address - Phone:816-607-1406
Practice Address - Fax:816-286-4112
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist