Organization
BODY RENOVATION HEALTH SERVICES, S.C.
Active
Organization
BODY RENOVATION HEALTH SERVICES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD WAGNER PT (PRESIDENT)
(262) 375-1075
Entity
Organization
Contact information
Practice address
2020 CHEYENNE CT, GRAFTON, WI 53024
(262) 375-1075
(262) 375-4975
Mailing address
4810 UPPER FOREST BEACH RD, PORT WASHINGTON, WI 53074-9715
(262) 375-1075
(262) 375-4975
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
06/04/2007
Last updated
08/22/2020
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