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1861040370
PRESTON THOMAS WAGNER
FORT WAYNE, IN
NPI
1861040370
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: IN 05013517A)
Enumeration Date
2019-08-28
Last Update Date
2019-08-28
Business Address
PRESTON THOMAS WAGNER
7617 W JEFFERSON BLVD STE D
FORT WAYNE, IN 46804-4164
Phone number: 260-436-8454
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Mailing Address
PRESTON THOMAS WAGNER
9602 COLDWATER RD STE 102
FORT WAYNE, IN 46825-2095
Phone number: 260-436-8454
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