LISA WAGONER

MEDFORD, OR
NPI1508124199
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: OR  8785)
Additional Taxonomies225200000X Physical Therapy Assistant
(Licence: ID  PTA-2842)
Enumeration Date2012-05-02
Last Update Date2023-05-01
Business Address
LISA WAGONER P.T.A.
400 CRATER LAKE AVE
MEDFORD, OR 97504-6808
Phone number: 541-613-6505
Mailing Address
LISA WAGONER P.T.A.
113 N ELM ST
CANBY, OR 97013-3519
Phone number: