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General NPI Number Information
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NPI Number | 1649427444
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Entity Type | Individual
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Provider Name | WENDY J GOHR PTA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 1661 SAINT ANTHONY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-3733
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Country | US
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Telephone | 651-842-5335
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Fax | 651-842-5272
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Provider Business Mailing Address
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Address Line | 310 SMITH AVE N STE 370
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City | SAINT PAUL
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State | MN
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Zip | 55102-2383
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Country | US
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Telephone | 651-767-3533
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Fax | 651-767-3515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A1178
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License Number State | MN
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