Individual
MR. ANDREW BLAKE WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7701 WEST KILGORE, STE 1A, YORKTOWN, IN 47396
(765) 759-5273
(765) 759-5519
Mailing address
10657 W 200 S, PARKER CITY, IN 47368
(765) 468-7297
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007376A
IN
Other
Enumeration date
04/22/2006
Last updated
07/08/2007
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