Individual
MRS. KELLY DANIELLE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
226 FISH HALL RD, BRUNSWICK, GA 31523-7405
(678) 687-7390
Mailing address
226 FISH HALL RD, BRUNSWICK, GA 31523-7405
(678) 687-7390
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001543
GA
Other
Enumeration date
01/20/2010
Last updated
12/18/2015
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