Individual
MR. KEVIN MATTHEW WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PT CERT MDT
Contact information
Practice address
11903 SAINT CHARLES ROCK RD, BRIDGETON, MO 63044-2623
(314) 770-0900
(314) 770-1673
Mailing address
BACK PAIN INSTITUTE OF ST. LOUIS LLC, 11903 ST. CHARLES ROCK RD., BRIDGETON, MO 63044
(314) 770-0900
(314) 739-8569
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
115026
MO
Other
Enumeration date
07/22/2005
Last updated
04/29/2010
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