Individual
DENISE K WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T
Contact information
Practice address
1634 W THISTLE DR, WYOMISSING, PA 19610-1273
(610) 301-3259
Mailing address
1634 W THISTLE DR, WYOMISSING, PA 19610-1273
(610) 301-3259
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013472L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02200101
BLUE CROSS
PA
01
—
WA917843
BLUE SHIELD
PA
Enumeration date
12/26/2006
Last updated
06/28/2016
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