Individual
MR. JASON WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
5500 CENTRAL AVE STE A, HOT SPRINGS, AR 71913-9712
(501) 701-4339
Mailing address
5500 CENTRAL AVE STE A, HOT SPRINGS, AR 71913-9712
(501) 701-4339
(501) 701-4246
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2449
AR
2251P0200X
Pediatric Physical Therapist
PT2449
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141072721
—
AR
Enumeration date
08/23/2006
Last updated
07/19/2023
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