Individual
LAURYN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
N84W16889 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2810
(262) 250-1870
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1682524
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100281568
—
WI
Enumeration date
06/20/2024
Last updated
08/15/2024
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