Provider Demographics
NPI:1245826668
Name:WUCHER, ANDREW CARL (PTA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CARL
Last Name:WUCHER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 OWL CT
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1599
Mailing Address - Country:US
Mailing Address - Phone:314-313-1942
Mailing Address - Fax:
Practice Address - Street 1:13612 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1447
Practice Address - Country:US
Practice Address - Phone:636-529-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117668225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant