Healthcare Provider Details

I. General information

NPI: 1750245411
Provider Name (Legal Business Name): OLIVIA WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37031 OLD MILL BRIDGE RD UNIT 2
SELBYVILLE DE
19975-3940
US

IV. Provider business mailing address

PO BOX 392573
PITTSBURGH PA
15251-1661
US

V. Phone/Fax

Practice location:
  • Phone: 302-564-7476
  • Fax: 302-564-7481
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: