Doctor Name: | AMANDA WAGNER |
NPI Number: | 1093065203 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | PT27555 |
Business Practice Address: | 2433 Country Place Blvd Bldg B Trinity, FL - 346551163 |
Business Phone Number: | 8138448200 |
Business Fax Number: | |
Mailing Address: | 2433 Country Place Blvd, Bldg B TRINITY |
State: | FL |
Postal Code: | 346551163 |
Phone Number: | 8138448200 |
Fax Number: | |
NPI Enumeration Date: | 09/14/2012 |
NPI Last Update Date: | 01/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT27555 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |