Healthcare Provider Details

I. General information

NPI: 1396075362
Provider Name (Legal Business Name): EUGENE ANTHONY WAGNER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FIFTH AVE
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

860 NORTHEAST DR
NORTH HUNTINGDON PA
15642-1980
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberPT008882L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: