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NPI Code Detail

MEDICARE: MS. LISA JEAN WAGERS PT

MEDICARE:  MS. LISA JEAN WAGERS  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist05004643AIN

General Provider Information

NPI Number : 1134298961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA JEAN WAGERS PT
Provider Business Mailing Address
First Line : 2505 TAYLOR RD
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-3102
Country : US
Telephone Number : 812-314-2378
Fax Number : 812-373-7616
Provider Business Practice Location Address
First Line : 2505 TAYLOR RD
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-3102
Country : US
Telephone Number : 812-314-2378
Fax Number : 812-373-7616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 07/08/2007

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Directions to “ MS. LISA JEAN WAGERS PT” Practice Location

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