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Individual
RICHARD WAGER
Active
Individual
RICHARD WAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
070004745
IL
2255A2300X
Athletic Trainer
096000735
IL
Other
Enumeration date
11/14/2005
Last updated
07/29/2016
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