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1871014480
JUDY WAGNER
PORT ORANGE, FL
NPI
1871014480
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: WY 0244)
Enumeration Date
2017-07-05
Last Update Date
2017-07-05
Business Address
JUDY WAGNER
5535 S WILLIAMSON BLVD STE 774
PORT ORANGE, FL 32128-8321
Phone number: 888-265-2680
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Mailing Address
JUDY WAGNER
731 HIRST ST
CHEYENNE, WY 82009-2505
Phone number:
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