Provider Demographics
NPI:1336550086
Name:WAGLER, TAELOUR (LMT)
Entity Type:Individual
Prefix:
First Name:TAELOUR
Middle Name:
Last Name:WAGLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 PATTERSON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8814
Mailing Address - Country:US
Mailing Address - Phone:970-243-1388
Mailing Address - Fax:
Practice Address - Street 1:2695 PATTERSON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8814
Practice Address - Country:US
Practice Address - Phone:970-243-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014527172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist