Individual
BETHANY WAGENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6809 N KNOXVILLE AVE, PEORIA, IL 61614-2812
(309) 981-8810
Mailing address
507 S WARREN ST, TREMONT, IL 61568-8565
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.009110
IL
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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