Wagoner, Lisa

Wagoner, Lisa is an individual health care provider with primary practice located at 400 Crater Lake Ave , Medford OR 97504-6808. 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. Wagoner, Lisa can be contacted via phone (541) 613-6505.

Contact Information

Primary practice address
400 Crater Lake Ave Medford OR 97504-6808
Phone: (541) 613-6505
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X PTA-2842 Idaho
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 8785 Oregon

Profile Details

NPI number 1508124199
LBN Legal business name Wagoner, Lisa
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2012
Last updated May 1st, 2023 - about 2 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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