Individual
GARTH WAGENMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
125 E ELM AVE, STE 103, FLAGSTAFF, AZ 86001-3258
(928) 779-1679
(928) 779-2822
Mailing address
125 E ELM AVE, STE 103, FLAGSTAFF, AZ 86001-3258
(928) 779-1679
(928) 779-2822
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7849
AZ
Other
Enumeration date
10/11/2007
Last updated
10/11/2007
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