Individual
DEREK WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2032 NEW CASTLE AVE, NEW CASTLE, DE 19720-7703
(302) 654-1700
Mailing address
1812 MARSH RD, STORE 505, WILMINGTON, DE 19810-4581
(302) 793-0432
(302) 793-0400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01275800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126199DBD
MEDICARE
NJ
01
—
P01013263
MCRR
MD
Enumeration date
04/18/2008
Last updated
04/26/2012
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