Doctor Name: | MR. WILLIAM WALLACE WAGGONER |
NPI Number: | 1255368049 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 05006050A |
Business Practice Address: | 2108 E Boulevard Kokomo, IN - 469022401 |
Business Phone Number: | 7656260200 |
Business Fax Number: | 7656260201 |
Mailing Address: | 205 W Wacker Dr, Suite 120 CHICAGO |
State: | IL |
Postal Code: | 606061216 |
Phone Number: | 3126400329 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2006 |
NPI Last Update Date: | 09/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05006050A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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 |