Lisa Wagner

NPI #1093825507 in East Hartford, Connecticut

Provider Information

NPI Number: 1093825507
Entity Type: Individual
Name: Lisa Wagner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Enumeration Date: Aug 30, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 477 CONNECTICUT BLVD
Address 2: STE 200
City: East Hartford
State: Connecticut
ZIP Code: 06108-3268
Phone: (860) 289-6021

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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