Provider Demographics
NPI:1235179847
Name:WOHLGEMUTH, PATRICIA GAYLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GAYLE
Last Name:WOHLGEMUTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:GAYLE
Other - Last Name:HEDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16325 JUSTUS POST RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4607
Mailing Address - Country:US
Mailing Address - Phone:319-321-4101
Mailing Address - Fax:
Practice Address - Street 1:9645 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6521
Practice Address - Country:US
Practice Address - Phone:314-968-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042536225200000X
IA00933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant