Individual
JACKLYN MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, ATC
Contact information
Practice address
50 FODEN ROAD, SUITE C, SOUTH PORTLAND, ME 04106
(207) 780-8860
Mailing address
100 GANNETT DR STE C, SOUTH PORTLAND, ME 04106-5900
(207) 347-2947
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5423
ME
Other
Enumeration date
11/23/2015
Last updated
03/25/2026
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