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NPI Code Detail

MEDICARE: KAREN LYNN WILD MPT

MEDICARE: KAREN LYNN WILD MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist114477MO
22251P0200XPediatric Physical Therapist114477MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023155033
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN LYNN WILD MPT
Provider Business Mailing Address
First Line : 3488 JEFFCO BLVD STE 102
Second Line :
City : ARNOLD
State : MO
Zip : 63010-6015
Country : US
Telephone Number : 636-464-5439
Fax Number : 636-464-5438
Provider Business Practice Location Address
First Line : 3488 JEFFCO BLVD STE 102
Second Line :
City : ARNOLD
State : MO
Zip : 63010-6015
Country : US
Telephone Number : 636-464-5439
Fax Number : 636-464-5438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 09/24/2024

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Directions to “ KAREN LYNN WILD MPT” Practice Location

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