| Doctor Name: | LISA WAGNER |
| NPI Number: | 1093825507 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 477 Connecticut Blvd Ste 200 East Hartford, CT - 061083268 |
| Business Phone Number: | 8602896021 |
| Business Fax Number: | |
| Mailing Address: | 76 Grande Rd, EAST HARTFORD |
| State: | CT |
| Postal Code: | 061182044 |
| Phone Number: | 8605683244 |
| Fax Number: | |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |