MEDICARE: DR. ALYSON MARGARET WAGNER DPT

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	035121	NY

General Provider Information

NPI Number	:	1770834541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSON MARGARET WAGNER DPT

Provider Business Mailing Address
First Line	:	3530 HENRY HUDSON PKWY
Second Line	:	APT PHB
City	:	BRONX
State	:	NY
Zip	:	10463-1306
Country	:	US
Telephone Number	:	917-612-1264
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 HENRY HUDSON PKWY
Second Line	:	APT PHB
City	:	BRONX
State	:	NY
Zip	:	10463-1306
Country	:	US
Telephone Number	:	917-612-1264
Fax Number	:

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

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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