Tanner Keith Wagner

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

0119010676 Issued in VA

Practice address

20716 Riverside Dr
Grundy, VA 24614-6747

Phone

(276) 935-6496

NPI assigned

Oct 29, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Merritt Physical Therapy & Reabilitation Inc. PC

  • Physical Therapist
  • Grundy, VA
  • NPI 1184774598
  NPD (past)

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1043032154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20716 RIVERSIDE DR",
            "city": "GRUNDY",
            "state": "VA",
            "postal_code": "246146747",
            "telephone_number": "276-935-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20716 RIVERSIDE DR",
            "city": "GRUNDY",
            "state": "VA",
            "postal_code": "246146747",
            "telephone_number": "276-935-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TANNER",
        "middle_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "0119010676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Dwayne Viers
• Nancy Michele Viers, RPH
• Virginia Department of Health
• Virginia Eyecare Clinic, LLC
• Virginia Medical and Respiratory Equipment, Inc.
• Wal-Mart Stores East LP
• Walgreen Co
• Marsha Danette Whited, FNP-BC
• Tara Williams-Matney, ARNP
• Jonathan Ryan Woods, PHARMD., RPH.

• Occupational Therapist in Grundy, VA
• Providers in Grundy, VA by specialty
• Occupational Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.