Healthcare Provider Details

I. General information

NPI: 1295869352
Provider Name (Legal Business Name): CHRISTINE VOGT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9541 HYDE PARK DR
AFFTON MO
63123-7341
US

IV. Provider business mailing address

9541 HYDE PARK DR
AFFTON MO
63123-7341
US

V. Phone/Fax

Practice location:
  • Phone: 314-638-2009
  • Fax:
Mailing address:
  • Phone: 314-638-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2004035095
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: