Provider Demographics
NPI:1972649010
Name:WOLGAST, MARCIA LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:LOUISE
Last Name:WOLGAST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 N BEACON HILL CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-4220
Mailing Address - Country:US
Mailing Address - Phone:316-684-9227
Mailing Address - Fax:
Practice Address - Street 1:9727 E SHANNON WOODS CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4102
Practice Address - Country:US
Practice Address - Phone:316-681-0824
Practice Address - Fax:316-219-1349
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist