Individual
MRS. ASHLEY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
300 SPRING ST, WESTBROOK, ME 04092-3915
(901) 592-8167
Mailing address
25 CORNELL ST, SOUTH PORTLAND, ME 04106-6147
(901) 592-8167
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PA6263
ME
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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