Most Relevant Information
Provider Data
| NPI Number: | 1003463290 |
| Provider Name: | ERIK WAGNER |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/22/2019 |
| Last Updated: | 08/22/2019 |
Provider Practice Location
10538 64TH RD APT 5J
FOREST HILLS
NY
113751628
Practice Location Phone/Fax
| Phone: | 9178060701 |
| Fax: |
Provider Mailing Location
576 BROADHOLLOW RD
MELVILLE
NY
117475002
Provider Mailing Phone/Fax
| Phone: | 6313595859 |
| Fax: |