# BODY RENOVATION PHYSICAL THERAPY SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Body Renovation Health Services SC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871664243
- **Authorized official:** MR. RICHARD D WAGNER JR. PT CSCS VCS (PARTNER)
- **Authorized official phone:** (262) 375-1075

## Contact information

- **Practice address:** 2020 CHEYENNE CT, GRAFTON, WI 53024-9368
- **Practice address phone:** (262) 375-1075
- **Practice address fax:** (262) 375-4975
- **Mailing address:** 2020 CHEYENNE CT, GRAFTON, WI 53024-9368
- **Mailing address phone:** (262) 375-1075
- **Mailing address fax:** (262) 375-4975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 11/10/2006
- **Last updated:** 01/30/2008