Individual
ETHAN JAMES WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
20320 I 30 # 190, BENTON, AR 72019-8027
(501) 500-8188
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5585
AR
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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