Individual
BRADLEY MANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
616 EXECUTIVE PARK, LOUISVILLE, KY 40207-4206
(502) 896-9355
Mailing address
8605 COOL BROOK CT, LOUISVILLE, KY 40291-1501
(502) 836-9240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005075
KY
Other
Enumeration date
02/13/2007
Last updated
01/30/2025
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