| NPI | 1952593550 |
|---|---|
| Former Name | LAURIE ANN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 5550) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009919) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2017-07-17 |