| NPI | 1881843761 |
|---|---|
| Former Name | EMILY FENNELL WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305205660) |
| 225100000X Physical Therapist (Licence: DC PT870914) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2023-09-06 |