Individual
JUDY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD STE 774, PORT ORANGE, FL 32128-8321
(888) 265-2680
Mailing address
731 HIRST ST, CHEYENNE, WY 82009-2505
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0244
WY
Other
Enumeration date
07/05/2017
Last updated
07/05/2017
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