Provider Demographics
NPI:1225396435
Name:STROZIER-WAGNER, JEANNE LESLIE (MS, RPT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LESLIE
Last Name:STROZIER-WAGNER
Suffix:
Gender:F
Credentials:MS, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 GLEN HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2233
Mailing Address - Country:US
Mailing Address - Phone:208-345-3575
Mailing Address - Fax:
Practice Address - Street 1:1004 GLEN HAVEN PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2233
Practice Address - Country:US
Practice Address - Phone:208-345-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics