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 1:10100 E SHANNON WOODS CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4106
Mailing Address - Country:US
Mailing Address - Phone:316-462-7450
Mailing Address - Fax:
Practice Address - Street 1:10100 E SHANNON WOODS CIR STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4106
Practice Address - Country:US
Practice Address - Phone:316-462-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist