Individual
ALYSSA WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
11988 MARK TWAIN LN, BRIDGETON, MO 63044-2825
(314) 291-8240
Mailing address
12153 LAKE PLACID DR, SAINT LOUIS, MO 63146-5112
(314) 520-1376
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01832
MO
Other
Enumeration date
01/31/2020
Last updated
01/31/2020
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