Wagner, Andrew

Wagner, Andrew is an individual health care provider with primary practice located at 855 S Main St , Oconto Falls WI 54154-1241. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Wagner, Andrew can be contacted via phone (920) 846-3444.

Contact Information

Primary practice address
855 S Main St Oconto Falls WI 54154-1241
Phone: (920) 846-3444
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 6070-24 Wisconsin

Profile Details

NPI number 1619140092
LBN Legal business name Wagner, Andrew
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2008
Last updated Apr 14th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619140092 NPPES
Wisconsin MEDICAID 11014110
Wisconsin Other 6070-24
Wisconsin MEDICAID 11014100
Wisconsin Other 390848401050

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