Provider Demographics
NPI:1598374597
Name:WAGNER, SASCHA VICTOIRE (DPT)
Entity type:Individual
Prefix:
First Name:SASCHA
Middle Name:VICTOIRE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FAIRGROUNDS RD STE B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:MT
Practice Address - Zip Code:59829-9204
Practice Address - Country:US
Practice Address - Phone:406-821-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19261225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist