Kerry Grimes Wagner, MPT

NPI #1194049056 in San Clemente, California

Provider Information

NPI Number: 1194049056
Entity Type: Individual
Name: Kerry Grimes Wagner, MPT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: MPT
Enumeration Date: Mar 22, 2010
Last Updated: Dec 22, 2011

Practice Location

Address: 1120 VIA CALLEJON STE B
City: San Clemente
State: California
ZIP Code: 92673-6264
Phone: (949) 481-1095

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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