Provider Demographics
NPI:1558471466
Name:WAGSTER, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WAGSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7147 SONYA DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5233
Mailing Address - Country:US
Mailing Address - Phone:901-588-0538
Mailing Address - Fax:
Practice Address - Street 1:164 MOUNT PELIA RD
Practice Address - Street 2:STE 102
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3812
Practice Address - Country:US
Practice Address - Phone:731-587-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6087OtherLICENSE#