| Doctor Name: | MR. SCOTT WAGNER |
| NPI Number: | 1053433128 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSPT |
| License Number: | 2305202514 |
| Business Practice Address: | 6849 Old Dominion Dr Mclean, VA - 221013724 |
| Business Phone Number: | 7038489333 |
| Business Fax Number: | |
| Mailing Address: | 516 Greenwich St, FALLS CHURCH |
| State: | VA |
| Postal Code: | 220462501 |
| Phone Number: | 7035878670 |
| Fax Number: | |
| NPI Enumeration Date: | 04/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 2305202514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |