Doctor Name: | LESLIE MICHELLE WAGNER |
NPI Number: | 1023139326 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | MT042949 |
Business Practice Address: | 2710 Civic Cir Amarillo, TX - 791091648 |
Business Phone Number: | 8062367234 |
Business Fax Number: | |
Mailing Address: | 2114 S Tyler St, AMARILLO |
State: | TX |
Postal Code: | 791092633 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT042949 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |