Individual
MR. MICHAEL T WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
280 EXEMPLA CIR, LAFAYETTE, CO 80026-3370
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3047
NM
225100000X
Physical Therapist
Primary
9520
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021706
KAISER COMMERCIAL NUMBER
CO
05
—
61238341
—
CO
Enumeration date
05/10/2006
Last updated
05/20/2021
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