Individual
SUSAN M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, CHT
Contact information
Practice address
85 PLEASANT DR, HASTINGS, MN 55033-1648
(651) 404-1002
Mailing address
1307 18TH ST W, HASTINGS, MN 55033-3212
Taxonomy
Speciality
Code
Description
License number
State
2251H1200X
Hand Physical Therapist
Primary
6588
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00366775
RAILROAD MEDICARE
MN
Enumeration date
08/23/2006
Last updated
04/03/2020
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