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General NPI Number Information
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NPI Number | 1427823830
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Entity Type | Individual
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Provider Name | ANASTASIA WAGNER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 2805 E GRAPEVINE MILLS CIR
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City | GRAPEVINE
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State | TX
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Zip | 76051-1210
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Country | US
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Telephone | 682-477-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 NORTHSTAR RD APT 8302
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City | DENTON
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State | TX
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Zip | 76208-1634
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Country | US
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Telephone |
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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 | 1386070
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License Number State | TX
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