Healthcare Provider Details

I. General information

NPI: 1235179847
Provider Name (Legal Business Name): PATRICIA GAYLE WOHLGEMUTH P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS PATRICIA GAYLE HEDRICK

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9645 BIG BEND BLVD
SAINT LOUIS MO
63122-6521
US

IV. Provider business mailing address

16325 JUSTUS POST RD
CHESTERFIELD MO
63017-4607
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-5460
  • Fax:
Mailing address:
  • Phone: 319-321-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2020042536
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00933
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: