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Individual

DR. KELLIE MARIE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT, CSCS

Contact information

Practice address
1223 MADISON ST, BEAVER DAM, WI 53916-2629
(920) 885-4750
Mailing address
5002 AUTUMN LEAF LN APT 210, MADISON, WI 53704-8654
(414) 416-2291

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11507-24
WI

Other

Enumeration date
10/04/2010
Last updated
10/04/2010
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