Provider Demographics
NPI:1003383266
Name:WISCH, LEXI KATHLEEN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LEXI
Middle Name:KATHLEEN
Last Name:WISCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LEXI
Other - Middle Name:KATHLEEN
Other - Last Name:MODGILN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7634 W BRUNO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2155
Mailing Address - Country:US
Mailing Address - Phone:309-242-0220
Mailing Address - Fax:
Practice Address - Street 1:401 HOLLY HILLS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2410
Practice Address - Country:US
Practice Address - Phone:314-353-5190
Practice Address - Fax:314-353-7631
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018023476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist