Individual
COLLEEN M WAGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
16455 STATESVILLE RD, SUITE 300, HUNTERSVILLE, NC 28078-7135
(704) 801-3719
(704) 801-3705
Mailing address
1691 OLD HARMONY DR NW, CONCORD, NC 28027-8031
(704) 674-9346
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8451
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079PU
BCBS NC
NC
05
—
7211860
—
NC
01
—
E1251
MEDCOST NC
NC
Enumeration date
07/30/2006
Last updated
09/10/2009
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