Provider Demographics
NPI:1255779922
Name:WAGGONER, JOHN HASTINGS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HASTINGS
Last Name:WAGGONER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 RIVER BLUFF TER
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-2553
Mailing Address - Country:US
Mailing Address - Phone:865-332-7422
Mailing Address - Fax:256-253-5633
Practice Address - Street 1:402 S WILSON DAM RD
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3662
Practice Address - Country:US
Practice Address - Phone:256-715-5868
Practice Address - Fax:256-253-5633
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6826225100000X
AL6826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist