Individual
MICHELLE RENAE WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
9713 W TONOPAH DR, PEORIA, AZ 85382-5110
(480) 381-0220
(623) 594-9094
Mailing address
9713 W TONOPAH DR, PEORIA, AZ 85382-5110
(480) 381-0220
(623) 594-9094
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8684
AZ
Other
Enumeration date
10/02/2009
Last updated
10/02/2009
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