Philip Wagener

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A2516 Issued in MD

Practice address

4730 Atrium CT
Owings Mills, MD 21117-3556

Phone

(410) 363-4790

NPI assigned

Oct 23, 2013

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

Other names 1

• Philip Henry Wagener Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1382486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382486400000",
    "number": "1194153577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 DRIVER RD",
            "city": "MARRIOTTSVILLE",
            "state": "MD",
            "postal_code": "211041325",
            "telephone_number": "443-262-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 ATRIUM CT",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173556",
            "telephone_number": "410-363-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENER",
        "first_name": "PHILIP",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-23",
        "last_updated": "2013-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A2516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHILIP",
            "last_name": "WAGENER",
            "middle_name": "HENRY",
            "credential": "PTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapy Assistant in Owings Mills, MD
• Providers in Owings Mills, MD by specialty
• Physical Therapy Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; 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.