Individual
AMY RUTH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2090 WOODWINDS DR, WOODBURY, MN 55125-2522
(651) 968-5801
(651) 968-5899
Mailing address
710 COMMERCE DR STE 200, WOODBURY, MN 55125-4925
(651) 968-5042
(651) 968-5904
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7581
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
679447500
—
MN
Enumeration date
10/11/2006
Last updated
07/02/2015
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