| Doctor Name: | TREVER WAGNER |
| NPI Number: | 1649629080 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, DPT |
| License Number: | 1898 |
| Business Practice Address: | 1110 W Omaha St # 3 Rapid City, SD - 577018120 |
| Business Phone Number: | 6057215950 |
| Business Fax Number: | |
| Mailing Address: | 6855 Daisy Dr, BLACK HAWK |
| State: | SD |
| Postal Code: | 577188202 |
| Phone Number: | 6057707331 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2016 |
| NPI Last Update Date: | 06/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1898 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| 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 |