Individual
MRS. HILLARY WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5931 BULLARD AVE STE 6, NEW ORLEANS, LA 70128-2817
(504) 243-6777
(504) 243-6736
Mailing address
663 JORDAN ST, SHREVEPORT, LA 71101-4748
(318) 222-8892
(318) 222-8893
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
09631
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09631
STATE LICENSE
LA
Enumeration date
11/06/2019
Last updated
05/13/2026
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