NPI 1710702402

Kyle Lawrence Wagoner

Practitioner Physical Therapy Assistant Fpo, AE

Practice location

Address: Psc 808 Box 431, Fpo, AE 09618-0005
Phone: (314) 629-6183

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X

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Registry record

NPI: 1710702402
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Nov 2024
Record last updated: 19 Nov 2024

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.