| NPI | 1578543971 |
|---|---|
| Other Name | TRACIE LYNN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT013716L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT000580) |
| 225100000X Physical Therapist (Licence: OH PT9363) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2017-01-10 |