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Individual

MATTHEW WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
2150 STADIUM DRIVE, BOULDER, CO 80309-1361
(303) 315-9900
(303) 315-9902
Mailing address
1514 CEDARWOOD DR, LONGMONT, CO 80504-8785
(207) 831-6697

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
029375
NY
225100000X
Physical Therapist
Primary
PTL.0010633
CO

Other

Enumeration date
06/08/2007
Last updated
09/29/2022
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