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1356177471
NATHAN WAGGONER
FORT WORTH, TX
NPI
1356177471
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: TX 2113657)
Enumeration Date
2024-09-13
Last Update Date
2024-09-13
Business Address
NATHAN WAGGONER
11801 SOUTH FREEWAY
FORT WORTH, TX 76115
Phone number: 817-551-2747
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Mailing Address
NATHAN WAGGONER
1017 RED CEDAR WAY
BURLESON, TX 76028-8320
Phone number:
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