Individual
KURT ALLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
200C PATEWOOD DR, GREENVILLE, SC 29615-3557
(864) 454-7422
Mailing address
112 SYLVAN OAK WAY, SIMPSONVILLE, SC 29681-2561
(864) 238-8689
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0705
SC
Other
Enumeration date
12/08/2023
Last updated
12/08/2023
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