Individual
DR. CHARLES AY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, DPT
Contact information
Practice address
69 RAILROAD AVE STE A4, HILO, HI 96720-7509
(808) 339-7861
Mailing address
25-3420 PAKELEKIA ST, HILO, HI 96720-1318
(808) 989-2487
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 2674
HI
Other
Enumeration date
06/29/2007
Last updated
07/21/2022
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