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General NPI Number Information
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NPI Number | 1881269298
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Entity Type | Individual
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Provider Name | LINDSEY SHAE WAGONER DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 3495 TEAYS VALLEY RD STE B
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City | HURRICANE
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State | WV
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Zip | 25526-9279
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Country | US
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Telephone | 304-760-9664
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MOUNT VERNON CIR
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City | HURRICANE
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State | WV
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Zip | 25526-9740
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Country | US
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Telephone | 304-940-9627
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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 |
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License Number State |
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