Individual
KAYLEIGH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
501 W 12TH ST, ERIE, PA 16501-1536
(814) 455-3719
Mailing address
1443 GREENFIELD DR, ERIE, PA 16509-2912
(814) 602-9206
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
RT006112
PA
Other
Enumeration date
08/21/2019
Last updated
08/21/2019
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