| Doctor Name: | STACY WAGNER |
| NPI Number: | 1801188750 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT |
| License Number: | |
| Business Practice Address: | 481 Gold Star Hwy Suite 302 Groton, CT - 063406702 |
| Business Phone Number: | 8604468254 |
| Business Fax Number: | 8604468293 |
| Mailing Address: | 270 Farmington Ave, Suite 303 FARMINGTON |
| State: | CT |
| Postal Code: | 060321909 |
| Phone Number: | 8604094595 |
| Fax Number: | 8604094860 |
| NPI Enumeration Date: | 05/11/2011 |
| NPI Last Update Date: | 05/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |