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General NPI Number Information
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NPI Number | 1003033846
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Entity Type | Individual
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Provider Name | TESSA WAGGONER PT
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 77 ROLLING OAKS DR STE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1017
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Country | US
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Telephone | 805-285-3562
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Fax | 805-364-4947
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Provider Business Mailing Address
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Address Line | 659 PEDRO ST
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City | CAMARILLO
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State | CA
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Zip | 93010-7739
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Country | US
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Telephone | 805-285-3562
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Fax | 805-364-4947
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24735
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License Number State | CA
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