Individual
MAKENZI WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
334 12TH AVE SE, NORMAN, OK 73071-5070
(405) 310-6590
Mailing address
1412 SW 23RD ST, MOORE, OK 73170-7471
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5619
OK
2251X0800X
Orthopedic Physical Therapist
5619
OK
Other
Enumeration date
07/03/2020
Last updated
07/08/2020
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