=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598374597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SASCHA VICTOIRE WAGNER DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2020
-----------------------------------------------------
Last Update Date | 10/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 N MAIN ST
-----------------------------------------------------
City | DARBY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59829-9204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-821-2021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 336 FAIRGROUNDS RD STE B
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59840-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 19261
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------