Provider Demographics
NPI:1194032896
Name:REY WAGNER, BRIGITTE (PTA)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:REY WAGNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S 216TH ST
Mailing Address - Street 2:WESLEY HOME
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198
Mailing Address - Country:US
Mailing Address - Phone:206-824-5000
Mailing Address - Fax:
Practice Address - Street 1:815 S 216TH ST
Practice Address - Street 2:WESLEY HOME
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198
Practice Address - Country:US
Practice Address - Phone:206-824-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant