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General NPI Number Information
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NPI Number | 1811373376
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Entity Type | Individual
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Provider Name | THOMAS WAGER II PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 958 E MAIN ST STE B
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City | SPARTANBURG
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State | SC
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Zip | 29302-2148
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Country | US
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Telephone | 864-278-0431
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Fax | 864-278-0461
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Provider Business Mailing Address
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Address Line | PO BOX 6526
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City | COLUMBIA
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State | SC
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Zip | 29260-6526
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Country | US
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Telephone | 803-693-5040
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Fax | 803-993-9472
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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 | 11708
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License Number State | SC
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