Individual
RICHARD WAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
2346 MASCOUTAH AVE, BELLEVILLE, IL 62220-3499
(618) 277-6282
(618) 277-6284
Mailing address
2346 MASCOUTAH AVE, BELLEVILLE, IL 62220-3499
(618) 277-6282
(618) 277-6284
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
070004745
IL
2255A2300X
Athletic Trainer
096000735
IL
Other
Enumeration date
11/14/2005
Last updated
07/29/2016
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