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General NPI Number Information
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NPI Number | 1295284040
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Entity Type | Individual
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Provider Name | ANDREW WAGNER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 1950 E 89TH ST
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City | CLEVELAND
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State | OH
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Zip | 44106-2008
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Country | US
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Telephone | 216-444-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 7424 W CROSS CREEK TRL
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City | BRECKSVILLE
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State | OH
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Zip | 44141-3185
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Country | US
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Telephone | 724-766-5306
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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 | PT016473
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License Number State | OH
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