Individual
TRACEY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
5601 DESOTO AVE, WOODLAND HILLSQ, CA 91365
(818) 719-2930
Mailing address
675 OAK PARK, 209, OAK PARK, CA 91377
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT 26158
CA
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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