Individual
NOAH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
505 COPPER ROAD, FRISCO, CO 80443
(888) 350-1544
Mailing address
305 CHADWYCK LN, LITITZ, PA 17543-7451
(845) 476-9824
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.0002450
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000051106
BOC
—
01
—
304994
NATA
PA
01
—
AT.0002450
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
02/19/2021
Last updated
06/08/2022
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