Provider Demographics
NPI:1295869352
Name:VOGT, CHRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VOGT
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 1:9541 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7341
Mailing Address - Country:US
Mailing Address - Phone:314-638-2009
Mailing Address - Fax:
Practice Address - Street 1:9541 HYDE PARK DR
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-7341
Practice Address - Country:US
Practice Address - Phone:314-638-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035095225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant