Individual
JAMES WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
316 MADISON ST, NILES, MI 49120-3128
(269) 921-0572
Mailing address
316 MADISON ST, NILES, MI 49120-3128
(269) 921-0572
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004181
MI
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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