MEDICARE: DR. BARBARA REDDIEN WAGNER PT, DPT, MHA

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	PT002631E	PA

General Provider Information

NPI Number	:	1831306745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA REDDIEN WAGNER PT, DPT, MHA

Provider Business Mailing Address
First Line	:	6 COVINGTON LAKE EST
Second Line	:
City	:	GOULDSBORO
State	:	PA
Zip	:	18424-9433
Country	:	US
Telephone Number	:	570-941-7936
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 COVINGTON LAKE EST
Second Line	:
City	:	GOULDSBORO
State	:	PA
Zip	:	18424-9433
Country	:	US
Telephone Number	:	570-941-7936
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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