Theresa Ann Wagoner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4661 Issued in NC

Practice address

60 Shuford Rd
Columbus, NC 28722-7406

Phone

(828) 894-0277

Fax

(828) 894-0278

NPI assigned

Jan 10, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Theresa Ann Lynch Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461888000000",
    "number": "1033268511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 SHUFORD RD",
            "city": "COLUMBUS",
            "state": "NC",
            "postal_code": "287227406",
            "telephone_number": "828-894-0277",
            "fax_number": "828-894-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 SHUFORD RD",
            "city": "COLUMBUS",
            "state": "NC",
            "postal_code": "287227406",
            "telephone_number": "828-894-0277",
            "fax_number": "828-894-0278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "THERESA",
        "middle_name": "ANN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2016-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "4661",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "8112",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "LYNCH",
            "middle_name": "ANN",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jeffrey Kip Viar, DO
• Krista Wagner
• Laura Gillie Walker
• Kymberly Setzer Wood, ARNP
• Chad Allan York, PA-C
• Elizabeth Lane York, MD
• Madison Zimmerman, MS, RD, LDN

• Physical Therapist in Columbus, NC
• Providers in Columbus, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.