| Organization Name: | BODY RENOVATION PHYSICAL THERAPY SC |
| NPI Number: | 1871664243 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD D WAGNER (PARTNER) |
| Mailing Address: | 2020 Cheyenne Ct Grafton |
| State: | WI US |
| Postal Code: | 530249368 |
| Phone Number: | 2623751075 |
| Fax Number: | 2623754975 |
| NPI Enumeration Date: | 11/10/2006 |
| NPI Last Update Date: | 01/30/2008 |
| 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 |