Provider Demographics
NPI:1265150601
Name:WAGNON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WAGNON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-701-4339
Mailing Address - Street 1:5500 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9712
Mailing Address - Country:US
Mailing Address - Phone:501-701-4339
Mailing Address - Fax:501-701-4246
Practice Address - Street 1:5500 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-9712
Practice Address - Country:US
Practice Address - Phone:501-701-4339
Practice Address - Fax:501-701-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty