KENNETH GABRIEL WAGONER

STATESVILLE, NC
NPI1164393674
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: NC  A8675)
Enumeration Date2025-09-16
Last Update Date2025-09-16
Business Address
-- KENNETH GABRIEL WAGONER PTA
1845 E BROAD ST
STATESVILLE, NC 28625-4307
Phone number: 980-890-3255
Mailing Address
-- KENNETH GABRIEL WAGONER PTA
184 REDEMPTION RD
STATESVILLE, NC 28625-1526
Phone number:
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