Individual
ELLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10640 N RIVERSIDE DR STE 200, FORT WORTH, TX 76244-9506
(817) 431-9000
Mailing address
10640 N RIVERSIDE DR STE 200, FORT WORTH, TX 76244-9506
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1333962
PT LICENSE NUMBER
TX
Enumeration date
08/19/2020
Last updated
08/19/2020
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