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General NPI Number Information
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NPI Number | 1104719970
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Entity Type | Individual
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Provider Name | KARYN ELIZABETH WAGNER
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Gender | Female
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Dates
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Enumeration Date | 05/31/2025
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 6330 E 75TH ST STE 206
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2700
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Country | US
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Telephone | 317-284-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 1385 JEFFREY CT W
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City | CARMEL
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State | IN
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Zip | 46032-1278
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Country | US
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Telephone | 317-403-7997
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 05008732A
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License Number State | IN
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