Organization
PHYSIOLIFE 605 PLLC
Active
Organization
PHYSIOLIFE 605 PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVER WAGNER PT, DPT, ATC (OWNER)
(605) 767-1601
Entity
Organization
Contact information
Practice address
220 S CLIFF AVE STE 102, HARRISBURG, SD 57032-2485
(605) 770-7331
Mailing address
220 S CLIFF AVE STE 102, HARRISBURG, SD 57032-2485
(605) 767-1601
(605) 767-1607
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/25/2023
Last updated
08/22/2023
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