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NPI Code Detail

MEDICARE: JEFFREY LYNN WAGNAAR P.T.

MEDICARE: JEFFREY LYNN WAGNAAR P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPTL-6924CO
2104100000XSocial Worker

General Provider Information

NPI Number : 1235254459
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY LYNN WAGNAAR P.T.
Provider Business Mailing Address
First Line : 325 KING ST
Second Line :
City : DENVER
State : CO
Zip : 80219-1326
Country : US
Telephone Number : 303-225-4100
Fax Number : 303-486-5501
Provider Business Practice Location Address
First Line : 325 KING ST
Second Line :
City : DENVER
State : CO
Zip : 80219-1326
Country : US
Telephone Number : 303-225-4100
Fax Number : 303-486-5501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 11/27/2023

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