Individual
AMBER ELISE OLIPHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
4800 MEXICO RD, STE 104, SAINT PETERS, MO 63376-1666
(636) 939-9540
(636) 939-9886
Mailing address
2454 W CLAY ST, SAINT CHARLES, MO 63301-2548
(636) 916-4625
(636) 916-4628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
07525R
LA
225100000X
Physical Therapist
Primary
2004035080
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12206763
CAQH ID
—
Enumeration date
02/26/2009
Last updated
09/08/2014
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