Doctor Name: | DEREK WAGNER |
NPI Number: | 1487828570 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 40QA01275800 |
Business Practice Address: | 2032 New Castle Ave New Castle, DE - 197207703 |
Business Phone Number: | 3026541700 |
Business Fax Number: | |
Mailing Address: | 1812 Marsh Rd, Store 505 WILMINGTON |
State: | DE |
Postal Code: | 198104581 |
Phone Number: | 3027930432 |
Fax Number: | 3027930400 |
NPI Enumeration Date: | 04/18/2008 |
NPI Last Update Date: | 04/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 40QA01275800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
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 |