Wagner, Carolyn

Wagner, Carolyn is an sole proprietor health care provider with primary practice located at 1130 N Westfield St , Oshkosh WI 54902-3217. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Wagner, Carolyn can be contacted via phone (920) 237-2163.

Contact Information

Primary practice address
1130 N Westfield St Oshkosh WI 54902-3217
Phone: (920) 237-2163
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 1176-19 Wisconsin

Profile Details

NPI number 1306002506
LBN Legal business name Wagner, Carolyn
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 6th, 2008
Last updated Aug 6th, 2008 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306002506 NPPES
Wisconsin MEDICAID 40460700

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