NPI 1083222905

Eric Wagner

Practitioner Massage Therapist Santa Rosa, CA

Practice location

Address: 2462 W 3rd St, Santa Rosa, CA 95401-6425
Phone: (707) 843-3539

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 82262 (CA)

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Registry record

NPI: 1083222905
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Jul 2020
Record last updated: 16 Jul 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.