Provider Demographics
NPI:1679501134
Name:WAGNER, CARA (PT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 COLT DR
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6471
Mailing Address - Country:US
Mailing Address - Phone:419-425-9872
Mailing Address - Fax:
Practice Address - Street 1:7595 COUNTY ROAD 236
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8738
Practice Address - Country:US
Practice Address - Phone:419-427-1984
Practice Address - Fax:419-427-2326
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-010861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2540021Medicaid
OH04764OtherPARAMOUNT
OH000000355386OtherANTHEM
OH9388187OtherPHCS
OHWA4147071OtherADMINISTAR FEDERAL
OHP00183681OtherRR MEDICARE
OH2540021Medicaid