Individual
ELIZABETH ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
17770 HALEAKALA HWY, KULA, HI 96790-8036
(808) 422-2288
Mailing address
17770 HALEAKALA HWY, KULA, HI 96790-8036
(808) 422-2288
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3198
HI
225100000X
Physical Therapist
PT60035296
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-3198
HAWAII LICENSE
HI
Enumeration date
08/18/2008
Last updated
05/12/2026
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