Healthcare Provider Details

I. General information

NPI: 1598374597
Provider Name (Legal Business Name): SASCHA VICTOIRE WAGNER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N MAIN ST
DARBY MT
59829-9204
US

IV. Provider business mailing address

336 FAIRGROUNDS RD STE B
HAMILTON MT
59840-3126
US

V. Phone/Fax

Practice location:
  • Phone: 406-821-2021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19261
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: