Provider Demographics
NPI:1225425523
Name:WAGER, COREY (DPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:WAGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 SILENT RAIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3001
Mailing Address - Country:US
Mailing Address - Phone:433-786-4477
Mailing Address - Fax:
Practice Address - Street 1:2140 SILENT RAIN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3001
Practice Address - Country:US
Practice Address - Phone:433-786-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0012697OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES