Individual provider Active NPI

Alyssa Headrick, DPT

  • Physical Therapist
  • Wentzville, MO
National Provider Identifier
1366333957
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2025028429 Issued in MO
Practice address
1229 Wentzville Pkwy Ste 209
Wentzville, MO 63385-3553
Phone
(636) 730-1118
NPI assigned
Jul 11, 2025
Last updated
Jul 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2025028429 MO Primary

Addresses

Primary practice location

1229 Wentzville Pkwy Ste 209
Wentzville, MO 63385-3553

Mailing address

1305 Lakeway Dr
Defiance, MO 63341-1432
Phone (314) 941-1016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250820002751 MO Practitioner - Physical Therapist in Private Practice 7719487214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Missouri, Columbia School of Medicine, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

14515 N Outer 40 Rd
Suite 110
Chesterfield, MO 63017-5746

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025028429MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Atr Tony LLC Physical Therapist CurrentSince Jul 16, 2025 Accepting new patients

Locations

14515 North Outer 40 Rd
Ste 110
Town and Country, MO 63017
Phone (314) 434-6060

1229 Wentzville Pkwy
Ste 209
Wentzville, MO 63385
Phone (636) 730-1118

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752192000000",
    "number": "1366333957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 LAKEWAY DR",
            "city": "DEFIANCE",
            "state": "MO",
            "postal_code": "633411432",
            "telephone_number": "314-941-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 WENTZVILLE PKWY STE 209",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853553",
            "telephone_number": "636-730-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEADRICK",
        "first_name": "ALYSSA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-11",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2025028429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wentzville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.