Individual
JAMES BLAKE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1525 COUNTRY CLUB RD, SHERWOOD, AR 72120-5076
(501) 978-3135
(501) 978-3138
Mailing address
1525 COUNTRY CLUB RD, SHERWOOD, AR 72120-5076
(501) 978-3135
(501) 978-3138
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
PT2565
AR
2251X0800X
Orthopedic Physical Therapist
Primary
PT2565
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5W797C153
AR BLUE CROSS BLUE SHIELD
AR
Enumeration date
05/01/2006
Last updated
03/11/2014
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