| Doctor Name: | ELIZABETH ANN WAGNER |
| NPI Number: | 1104216555 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | PT30032 |
| Business Practice Address: | 11482 Okeechobee Blvd Suite 2 Royal Palm Beach, FL - 334118735 |
| Business Phone Number: | 5614320111 |
| Business Fax Number: | 5614321075 |
| Mailing Address: | 6169 S Jog Rd, Suite A11 LAKE WORTH |
| State: | FL |
| Postal Code: | 334676579 |
| Phone Number: | 5614320111 |
| Fax Number: | 5614321075 |
| NPI Enumeration Date: | 01/23/2015 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT30032 |
| 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 |