Active NPI
Lisa Wagner
- Physical Therapist
- East Hartford, CT
National Provider Identifier
1093825507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 477 Connecticut Blvd
Ste 200
East Hartford, CT 06108-3268 - Phone
- (860) 289-6021
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
477 Connecticut Blvd
Ste 200
East Hartford, CT 06108-3268
Mailing address
76 Grande Rd
East Hartford, CT 06118-2044
Phone (860) 568-3244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000858 | Other | CT | LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093825507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 GRANDE RD",
"city": "EAST HARTFORD",
"state": "CT",
"postal_code": "061182044",
"telephone_number": "860-568-3244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "477 CONNECTICUT BLVD",
"address_2": "STE 200",
"city": "EAST HARTFORD",
"state": "CT",
"postal_code": "061083268",
"telephone_number": "860-289-6021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "000858",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.