Provider Demographics
NPI:1619636743
Name:WAGLE, SURBHI
Entity Type:Individual
Prefix:
First Name:SURBHI
Middle Name:
Last Name:WAGLE
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 1:313 FLINTROCK CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1348
Mailing Address - Country:US
Mailing Address - Phone:706-207-5222
Mailing Address - Fax:
Practice Address - Street 1:313 FLINTROCK CT
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1348
Practice Address - Country:US
Practice Address - Phone:706-207-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist