Individual
DONNA LYNN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
660 BLUE MOUNTAIN PKWY, HARRISBURG, PA 17112-9415
(814) 591-0725
Mailing address
660 BLUE MOUNTAIN PKWY, HARRISBURG, PA 17112-9415
(814) 591-0725
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE012852
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62051
—
PA
Enumeration date
09/05/2021
Last updated
09/05/2021
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