ETHAN JAMES WAGNER

BENTON, AR
NPI1104640879
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: AR  PT5585)
Enumeration Date2024-11-11
Last Update Date2024-11-11
Business Address
ETHAN JAMES WAGNER DPT
20320 I 30 # 190
BENTON, AR 72019-8027
Phone number: 501-500-8188
Mailing Address
ETHAN JAMES WAGNER DPT
1200 CORPORATE DR STE 400
HOOVER, AL 35242-5424
Phone number: 423-238-7217
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