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Individual

JOHN WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
9964 W 144TH ST, ORLAND PARK, IL 60462-2458
(708) 460-8027
Mailing address
3098 23RD AVE, MARION, IA 52302-1607
(319) 899-8387

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
004345
IA

Other

Enumeration date
10/15/2009
Last updated
10/15/2009
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