Wagner, Charles Tom

Wagner, Charles Tom is an individual health care provider with primary practice located at 754 N College Rd Ste D, Twin Falls ID 83301-5822. 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, Charles Tom can be contacted via phone (208) 734-5313.

Contact Information

Primary practice address
754 N College Rd Ste D Twin Falls ID 83301-5822
Phone: (208) 734-5313
Fax: (208) 736-1582
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X RPT-208 Idaho

Profile Details

NPI number 1891858809
LBN Legal business name Wagner, Charles Tom
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2006
Last updated Apr 5th, 2013 - about 12 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 1891858809 NPPES
Idaho MEDICAID 002620200

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