Provider Demographics
NPI:1215136387
Name:MALTAGLIATI, BRIGID (PTA)
Entity type:Individual
Prefix:
First Name:BRIGID
Middle Name:
Last Name:MALTAGLIATI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRIGID
Other - Middle Name:
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-892-6048
Mailing Address - Fax:314-487-3062
Practice Address - Street 1:4850 LEMAY FERRY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1576
Practice Address - Country:US
Practice Address - Phone:314-416-1707
Practice Address - Fax:314-416-7184
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant