Individual
MRS. SALLY MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
400 N 7TH ST, MARIETTA, OH 45750-2024
(740) 376-1084
Mailing address
1665 HACKNEY RD, BEVERLY, OH 45715-8700
(740) 558-9904
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA05723
OH
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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