Organization
BODY RENOVATION PHYSICAL THERAPY SC
Active
Other names
Body Renovation Health Services SC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD D WAGNER JR. PT CSCS VCS (PARTNER)
(262) 375-1075
Entity
Organization
Contact information
Practice address
2020 CHEYENNE CT, GRAFTON, WI 53024-9368
(262) 375-1075
(262) 375-4975
Mailing address
2020 CHEYENNE CT, GRAFTON, WI 53024-9368
(262) 375-1075
(262) 375-4975
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/10/2006
Last updated
01/30/2008
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