DR. Kellie Marie Wagner, PT, DPT, CSCS

NPI #1144539461 in Beaver Dam, Wisconsin

Provider Information

NPI Number: 1144539461
Entity Type: Individual
Name: DR. Kellie Marie Wagner, PT, DPT, CSCS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT, DPT, CSCS
Enumeration Date: Oct 4, 2010
Last Updated: Oct 4, 2010

Practice Location

Address: 1223 MADISON ST
City: Beaver Dam
State: Wisconsin
ZIP Code: 53916-2629
Phone: (920) 885-4750

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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