Organization
WAGNER PT & PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY R WAGNER PT, DPT (OWNER)
(626) 221-2628
Entity
Organization
Contact information
Practice address
290 BEDFORD ST, LAKEVILLE, MA 02347
(508) 938-9787
Mailing address
376 LAUREL ST, BRIDGEWATER, MA 02324-2705
(626) 221-2628
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1346-AH-PF
MA
Other
Enumeration date
05/02/2018
Last updated
07/12/2018
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