Individual
COREY WAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12697
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012697
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
04/24/2015
Last updated
10/14/2021
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