Healthcare Provider Details

I. General information

NPI: 1558555326
Provider Name (Legal Business Name): NAPOLEON PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 WOODLAWN AVE SUITE 1
NAPOLEON OH
43545-1178
US

IV. Provider business mailing address

1322 WOODLAWN AVE SUITE 1
NAPOLEON OH
43545-1178
US

V. Phone/Fax

Practice location:
  • Phone: 419-599-0888
  • Fax: 419-599-0087
Mailing address:
  • Phone: 419-599-0888
  • Fax: 419-599-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9959
License Number StateOH

VIII. Authorized Official

Name: MR. JEFFERY BUDD WAGNER
Title or Position: PT/OWNER
Credential: PT
Phone: 419-599-0888