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Individual

MRS. AMY MARIE WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPTA

Contact information

Practice address
35300 KAISER CT, WILLOUGHBY, OH 44094-6633
(440) 510-8047
Mailing address
5065 WAKE ROBIN RD # 0, MENTOR, OH 44060-1334
(440) 221-5270

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06888
OH

Other

Enumeration date
04/12/2010
Last updated
04/12/2010
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