Provider Demographics
NPI:1558532192
Name:RODNEY, MEG WAGNER (PT)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:WAGNER
Last Name:RODNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:ELLEN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 25385
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-1317
Mailing Address - Country:US
Mailing Address - Phone:928-210-2413
Mailing Address - Fax:928-819-7019
Practice Address - Street 1:11426 E DEL GOLFO
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-8952
Practice Address - Country:US
Practice Address - Phone:928-210-2413
Practice Address - Fax:928-819-7019
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50162251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ465113Medicaid