Individual
JANE PAULA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT, PCS
Contact information
Practice address
304 PECOS TRL, IRVING, TX 75063-4541
(214) 405-2394
Mailing address
304 PECOS TRL, IRVING, TX 75063-4541
(214) 405-2394
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1025898
TX
Other
Enumeration date
08/30/2010
Last updated
08/30/2010
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