| Doctor Name: | MR. ANDREW BLAKE WAGNER |
| NPI Number: | 1306802087 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 05007376A |
| Business Practice Address: | 7701 West Kilgore Ste 1a Yorktown, IN - 47396 |
| Business Phone Number: | 7657595273 |
| Business Fax Number: | 7657595519 |
| Mailing Address: | 10657 W 200 S, PARKER CITY |
| State: | IN |
| Postal Code: | 47368 |
| Phone Number: | 7654687297 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05007376A |
| 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 |