Basic Information
| Provider Information | |||||||||
| NPI: | 1679501134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAGNER | ||||||||
| FirstName: | CARA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 COLT DR | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458406471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194259872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7595 COUNTY ROAD 236 | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458408738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194271984 | ||||||||
| FaxNumber: | 4194272326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-010861 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2540021 | 05 | OH | MEDICAID | 04764 | 01 | OH | PARAMOUNT | OTHER | 000000355386 | 01 | OH | ANTHEM | OTHER | 9388187 | 01 | OH | PHCS | OTHER | WA4147071 | 01 | OH | ADMINISTAR FEDERAL | OTHER | P00183681 | 01 | OH | RR MEDICARE | OTHER |