Bradley Mann Wagner, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

005075 Issued in KY

Practice address

616 Executive Park
Louisville, KY 40207-4206

Phone

(502) 896-9355

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

Yes

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)

Enrolled

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1184766362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8605 COOL BROOK CT",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402911501",
            "telephone_number": "502-836-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 EXECUTIVE PARK",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074206",
            "telephone_number": "502-896-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRADLEY",
        "middle_name": "MANN",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "005075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Katherine Wafzig
• Sarah Katherine Wagers, M.D.
• Erin Elizabeth Waggoner
• Jessica Nicole Waggoner, PTA
• Blair Kelly Wagner, DNP
• Cynthia Yvonne Wagner
• Dana Wagner
• Dennis E Wagner, ED.D.
• Jake Wagner
• Jessica Ann Wagner, RPH, PHARMD, BCPS

• Physical Therapist in Louisville, KY
• Providers in Louisville, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.