Doctor Name: | MRS. JENNIFER LEE WAGONER |
NPI Number: | 1861785206 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 070015942 |
Business Practice Address: | 625 E Monroe St Cuba, IL - 614275109 |
Business Phone Number: | 3097855012 |
Business Fax Number: | |
Mailing Address: | 325 Jamestown Rd, MACOMB |
State: | IL |
Postal Code: | 614559328 |
Phone Number: | 8157573954 |
Fax Number: | |
NPI Enumeration Date: | 05/18/2011 |
NPI Last Update Date: | 05/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 070015942 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |