Individual
BLAIR ELLEN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 MONARCH ST, SUITE 110, LEXINGTON, KY 40513-1495
(859) 224-0834
Mailing address
115 WEST DR, MURRAY, KY 42071-9830
(270) 293-0758
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT 3141
AR
2251P0200X
Pediatric Physical Therapist
Primary
PT005412
KY
Other
Enumeration date
04/28/2009
Last updated
04/09/2010
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