Individual
MR. BRYAN J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT, ATC, LAT
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
1045 RIVERSIDE AVE, 190, JACKSONVILLE, FL 32204
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AL4839
FL
225X00000X
Occupational Therapist
Primary
OT24282
FL
Other
Enumeration date
07/18/2017
Last updated
10/21/2024
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