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General NPI Number Information
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NPI Number | 1083264758
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Entity Type | Individual
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Provider Name | ALLISON NICOLE WAGNER DPT
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 179 LINWOOD AVE UNIT A-4
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City | COLCHESTER
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State | CT
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Zip | 06415-1100
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Country | US
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Telephone | 860-603-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 10219 VILLA PALAZZO CT
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City | TAMPA
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State | FL
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Zip | 33615-3098
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Country | US
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Telephone | 845-489-1320
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14827
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 044682
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License Number State | NY
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