Individual
JAMIE LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10445 DUPONT OAKS BLVD, FORT WAYNE, IN 46845-8792
(260) 471-4770
Mailing address
5610 WOODHEATH AVE, FORT WAYNE, IN 46809-2048
(419) 779-1936
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005248A
IN
Other
Enumeration date
02/16/2017
Last updated
10/01/2019
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