Individual
MICAIAH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
5400 GARY ST, FORT SMITH, AR 72903-4744
(918) 658-0975
Mailing address
411 BETTY LOU RD, POTEAU, OK 74953-5221
(918) 658-0975
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6526
OK
Other
Enumeration date
01/27/2026
Last updated
01/27/2026
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