Organization
GREATER PT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICAIAH WAGNER PT,DPT (OWNER)
(918) 658-0975
Entity
Organization
Contact information
Practice address
5400 GARY ST, FORT SMITH, AR 72903-4744
(918) 658-0975
Mailing address
701 SOUTH ST, MOUNTAIN HOME, AR 72653-4452
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/11/2026
Last updated
02/11/2026
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