| Ethan James Wagner, DPT | |
|
20320 I 30 # 190, Benton, AR 72019-8027 | |
| (501) 500-8188 | |
| Not Available |
| Full Name | Ethan James Wagner |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 20320 I 30 # 190, Benton, Arkansas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104640879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT5585 (Arkansas) | Primary |
| Provider Name | Serc Rehabilitation Partners Llc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1760745244 PECOS PAC ID: 9830344563 Enrollment ID: O20150220000556 |
| Mailing Address | Practice Location Address |
|---|---|
| Ethan James Wagner, DPT 1200 Corporate Dr Ste 400, Hoover, AL 35242-5424 Ph: (423) 238-7217 | Ethan James Wagner, DPT 20320 I 30 # 190, Benton, AR 72019-8027 Ph: (501) 500-8188 |
Derick Ray Hampel, PT, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 105 Mcneil St, Benton, AR 72015 Phone: 501-315-0984 | |
Erin Elizabeth Andrews, MS, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 5701 Springhill Road, Benton, AR 72015 Phone: 501-653-2255 Fax: 501-653-2257 | |
William Anthony Taylor, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1214 Salem Road, Suite A, Benton, AR 72019 Phone: 501-915-4354 | |
Ms. Kathyrn Elaine Sandusky, MS PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 17706 I-30, Ste 3, Benton, AR 72015 Phone: 501-315-4414 Fax: 501-315-3467 | |
Mr. Richard Dale Stevens, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 2010 Active Way, Benton, AR 72019 Phone: 501-315-0984 | |
Marla Jo Murphy, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 2113 Watts Rd, Benton, AR 72015 Phone: 501-778-4960 Fax: 501-778-4968 | |
Mrs. Carrie Anne Johnson, MPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1102 W South St, Suite 10, Benton, AR 72015 Phone: 559-202-9637 |