Individual
REBECCA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1460 ELK CREEK DR, IDAHO FALLS, ID 83404-8237
(208) 535-1286
(208) 535-1291
Mailing address
1460 ELK CREEK DR, IDAHO FALLS, ID 83404-8237
(208) 535-1286
(208) 535-1291
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3742
NM
225100000X
Physical Therapist
Primary
PT-4365
ID
Other
Enumeration date
08/28/2009
Last updated
03/15/2022
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