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Individual
KRISTIN WAGNER
Active
Individual
KRISTIN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070011465
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00931608
MEDICARE RAILROAD
IL
Enumeration date
10/03/2007
Last updated
06/18/2024
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