Individual
JODEE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
111 S BROADWAY, PENNSVILLE, NJ 08070-2038
(856) 678-4701
Mailing address
3 CAROLINE CT, PILESGROVE, NJ 08098-2741
(609) 202-9616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01004500
NJ
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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