Individual
MR. JOSHUA JAMES WAGEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, DPT, CSCS
Contact information
Practice address
951 E PLAZA DR STE 110, EAGLE, ID 83616-6567
(208) 274-9580
Mailing address
5049 E GERANIUM ST, BOISE, ID 83716-7044
(208) 870-1882
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT-3184
ID
363A00000X
Physician Assistant
Primary
PA-1896
ID
Other
Enumeration date
07/24/2013
Last updated
03/09/2021
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