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Organization
BODY RENOVATION PHYSICAL THERAPY SC
Active
Organization
BODY RENOVATION PHYSICAL THERAPY SC
Active
Other names
Body Renovation Health Services SC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD D WAGNER JR. PT CSCS VCS (PARTNER)
(262) 375-1075
Entity
Organization
Contact information
Practice address
2020 CHEYENNE CT, GRAFTON, WI 53024-9368
(262) 375-1075
(262) 375-4975
Mailing address
2020 CHEYENNE CT, GRAFTON, WI 53024-9368
(262) 375-1075
(262) 375-4975
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/10/2006
Last updated
01/30/2008
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