Individual
ELIZABETH HANSEN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
266 OCKLEY DR, SHREVEPORT, LA 71105-3025
(318) 868-3268
(318) 861-2714
Mailing address
266 OCKLEY DR, SHREVEPORT, LA 71105-3025
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08371
LA
Other
Enumeration date
03/04/2014
Last updated
03/17/2018
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