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Individual
DR. JEFFREY TODD WAGNER
Active
Individual
DR. JEFFREY TODD WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
023281
NY
2251X0800X
Orthopedic Physical Therapist
Primary
023281
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127516
VYTRA
NY
01
—
828749
MANAGED PHYSICAL NETWORK
NY
01
—
QN6131
BC/BS
NY
Enumeration date
10/03/2006
Last updated
09/11/2025
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