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General NPI Number Information
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NPI Number | 1265150601
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Entity Type | Organization
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Legal Business Name | WAGNON PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 5500 CENTRAL AVE STE A
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City | HOT SPRINGS
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State | AR
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Zip | 71913-9712
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Country | US
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Telephone | 501-701-4339
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Fax | 501-701-4246
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Provider Business Mailing Address
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Address Line | 5500 CENTRAL AVE STE A
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City | HOT SPRINGS
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State | AR
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Zip | 71913-9712
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Country | US
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Telephone | 501-701-4339
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Fax | 501-701-4246
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | WILLIAM SAUNDERS
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Credential |
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Telephone | 501-701-4339
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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 |
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License Number State |
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