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MARIAH NICOLE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
1634 SW 122ND ST, OKLAHOMA CITY, OK 73170-4859
(405) 692-2366
Mailing address
10803 TURTLE BACK DR, OKLAHOMA CITY, OK 73130-8272
(580) 484-1260

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5816
OK

Other

Enumeration date
06/10/2020
Last updated
08/13/2020
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