Individual
CHRISTOPHER J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
52 RISING SUN TOWN CTR, RISING SUN, MD 21911-1902
(410) 657-0100
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
23588
MD
225100000X
Physical Therapist
Primary
J10002581
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01033233
MEDICARE RAILROAD
MD
Enumeration date
03/19/2010
Last updated
06/21/2012
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