Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2018028527 | MO |
NPI | 1982230462 |
---|---|
Provider Name | Alison Wickenheiser |
First Address | Wentzville, MO 63385-3823 |
Second Address | Wentzville, MO 63385-3823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2020 |
Last Update Date | 17/03/2020 |