Wagner, Lisa
Wagner, Lisa is an individual health care provider with primary practice located at 477 Connecticut Blvd Ste 200, East Hartford CT 06108-3268. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Wagner, Lisa can be contacted via phone (860) 289-6021.Contact Information
Primary practice address
477 Connecticut Blvd Ste 200
East Hartford CT 06108-3268
Phone: (860) 289-6021
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X |
Profile Details
| NPI number | 1093825507 |
|---|---|
| LBN Legal business name | Wagner, Lisa |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093825507 | NPPES |
| Connecticut | Other | 000858 | LICENSE # |
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