Individual
DIETRICH B WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1505 SPRINGBROOK DR, CEDAR FALLS, IA 50613-4994
(515) 664-0171
Mailing address
4133 64TH ST, URBANDALE, IA 50322-2705
(515) 664-0171
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/06/2023
Last updated
05/23/2025
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