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General NPI Number Information
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NPI Number | 1598651192
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Entity Type | Individual
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Provider Name | LAUREN WAGNER
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Gender | Female
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1220 W POPLAR ST STE A
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City | WALLA WALLA
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State | WA
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Zip | 99362-2757
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Country | US
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Telephone | 503-593-2613
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Fax |
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Provider Business Mailing Address
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Address Line | 2335 OSWEGO GLEN CT
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-1548
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Country | US
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Telephone | 503-593-2613
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 14223358-2401
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License Number State | UT
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