Individual
MR. SCOTT WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3015 UTAH AVE S, SUITE 200, SAINT LOUIS PARK, MN 55426-3671
(952) 933-1121
(952) 945-9635
Mailing address
3015 UTAH AVE S, SUITE 200, SAINT LOUIS PARK, MN 55426-3671
(952) 933-1121
(952) 945-9635
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4604
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4604
MHP
MN
01
—
HP46100
HP
MN
Enumeration date
06/16/2006
Last updated
07/08/2007
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