Michelle Renae Wagoner
Physical Therapist
9713 W Tonopah Dr
Peoria
, Arizona 85382-5110
Michelle Renae Wagoner
Physical Therapist
9713 W Tonopah Dr
Peoria
, Arizona 85382-5110
(623) 594-9094
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About
Features
Specialties
- Physical Therapist
Languages spoken
- English
Location
First Address
- Michelle Renae Wagoner
- 9713 W Tonopah Dr
- Peoria, AZ
- Zip : 85382-5110
- Fax : (623) 594-9094
- Phone : (480) 381-0220
Second Address
- Michelle Renae Wagoner
- 9713 W Tonopah Dr
- Peoria, AZ
- Zip : 85382-5110
- Fax : (623) 594-9094
- Phone : (480) 381-0220
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 8684 | AZ |
National Provider Identifier
| NPI | 1003141433 |
|---|---|
| Provider Name | Michelle Renae Wagoner |
| First Address | Peoria, AZ 85382-5110 |
| Second Address | Peoria, AZ 85382-5110 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/10/2009 |
| Last Update Date | 02/10/2009 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.