Individual
PRESTON THOMAS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7617 W JEFFERSON BLVD STE D, FORT WAYNE, IN 46804-4164
(260) 436-8454
(260) 489-9121
Mailing address
9602 COLDWATER RD STE 102, FORT WAYNE, IN 46825-2095
(260) 436-8454
(260) 489-9121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013517A
IN
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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