Provider Demographics
NPI:1568895324
Name:WAGNER, LINDSEY RENEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:RENEE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:20325 N 51ST AVE BLDG 6
Mailing Address - Street 2:STE 148
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5674
Mailing Address - Country:US
Mailing Address - Phone:623-249-3216
Mailing Address - Fax:623-249-3218
Practice Address - Street 1:20325 N 51ST AVE BLDG 6
Practice Address - Street 2:STE 148
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:623-249-3216
Practice Address - Fax:623-249-3218
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic