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Individual

MICHAEL TANNER WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
718 HAIKU RD, HAIKU, HI 96708-5846
(435) 669-5171
Mailing address
15950 HALEAKALA HWY, KULA, HI 96790-8015
(435) 669-5171

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-12842
HI

Other

Enumeration date
03/20/2024
Last updated
03/20/2024
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