MEDICARE: MICHELLE WAGNER-SKINNER PT

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
1	225100000X	Physical Therapist	PT017091	OH

General Provider Information

NPI Number	:	1386419802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE WAGNER-SKINNER PT

Provider Business Mailing Address
First Line	:	6701 ROCKSIDE RD STE 103
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2316
Country	:	US
Telephone Number	:	330-670-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 ROCKSIDE RD STE 103
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2316
Country	:	US
Telephone Number	:	330-670-4141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	01/12/2026

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