Individual
TORIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
9909 MEDICAL CENTER DR, ROCKVILLE, MD 20850-6361
(240) 864-6000
Mailing address
3462 ANDREW CT APT 203, LAUREL, MD 20724-2365
(707) 813-1315
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A00917
MD
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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