Active NPI
Elizabeth Forsythe Wagner, MSPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1104095306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10521
- Practice address
- 11590 W Bernardo CT Ste 100
San Diego, CA 92127-1624 - Phone
- (858) 432-4749
- NPI assigned
- Feb 21, 2008
- 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 | 10521 | MA | Primary |
Addresses
Primary practice location
11590 W Bernardo CT Ste 100
San Diego, CA 92127-1624
Mailing address
11590 W Bernardo CT Ste 100
San Diego, CA 92127-1624
Phone (858) 432-4749
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10521 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunny Days of California | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Occupational Therapist
- San Diego, CA
- NPI 1205100138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431993600000",
"number": "1104095306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11590 W BERNARDO CT STE 100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921271624",
"telephone_number": "858-432-4749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11590 W BERNARDO CT STE 100",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921271624",
"telephone_number": "858-432-4749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ELIZABETH",
"middle_name": "FORSYTHE",
"name_prefix": "Ms.",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-21",
"last_updated": "2015-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "10521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.