Individual
JORDAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 FORDHAM DR, VIRGINIA BEACH, VA 23464-5368
(757) 361-3951
Mailing address
1701 WHILE LN, NORFOLK, VA 23518-4821
(757) 270-2401
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2305217318
VA
Other
Enumeration date
08/09/2025
Last updated
08/13/2025
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