Provider Demographics
NPI:1497415632
Name:WUERTH, MARIA MCKIERNAN (PTA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MCKIERNAN
Last Name:WUERTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2625
Mailing Address - Country:US
Mailing Address - Phone:502-386-0803
Mailing Address - Fax:
Practice Address - Street 1:3013 WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2625
Practice Address - Country:US
Practice Address - Phone:502-386-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01503208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty