Matthew Wagner, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL.0010633 Issued in CO

Practice address

2150 Stadium Drive
Boulder, CO 80309-1361

Phone

(303) 315-9900

Fax

(303) 315-9902

NPI assigned

Jun 8, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Boulder Community Health

  • General Acute Care Hospital
  • Boulder, CO
  • NPI 1821074196
  Medicare reassignment Care Compare group NPD
• Boulder Community Health

  • Primary Care Clinic/Center
  • Boulder, CO
  • NPI 1740837137
  NPD
• Boulder Community Health

  • Medical Specialty Clinic/Center
  • Boulder, CO
  • NPI 1790332187
  NPD
• Boulder Community Health

  • Medical Specialty Clinic/Center
  • Boulder, CO
  • NPI 1407685498
  NPD (past)
• Boulder Community Health

  • Multi-Specialty Clinic/Center
  • Boulder, CO
  • NPI 1609822030
  NPD (past)
• Select Physical Therapy Holdings Inc

  • Physical Therapy Clinic/Center
  • Englewood, CO
  • NPI 1265401897

  Physical Therapist

  NPD (past)
• Empire Fitness & Physical Therapy

  • Physical Therapist
  • Watervliet, NY
  • NPI 1861484602
  NPD (past)
• Orthounited, Inc.

  • Orthopaedic Surgery Physician
  • North Canton, OH
  • NPI 1649236142

  Physical Therapist

  NPD (past)
• Waypoint Minnesota PC

  • Chiropractor
  • Maple Grove, MN
  • NPI 1699112805
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1043413859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 CEDARWOOD DR",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805048785",
            "telephone_number": "207-831-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 STADIUM DRIVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803091361",
            "telephone_number": "303-315-9900",
            "fax_number": "303-315-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MATTHEW",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "029375",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0010633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justina Pittman Wagers, PSY.D.
• Dylan Kurt Wagner, PT, DPT
• John M. Wagner, M.S.
• Jonathan Stuart Wagner, LPCC
• Kristin M Wagner, M.A., L.P.C., N.C.C.
• Jamal Waire, PSYD
• Kaylin Wakuzawa
• Audrey M Waldron, P.T.
• Waldron'S Peak Physical Therapy, P.C.
• Abigail Esther Wales

• Physical Therapist in Boulder, CO
• Providers in Boulder, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.