Active NPI
Phillip Ray Waggoner, P.T.
- Physical Therapist
- Coral Gables, FL
National Provider Identifier
1205018710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 7485
- Practice address
- 5915 Ponce de Leon Blvd
Plumer BLDG.,5TH Floor
Coral Gables, FL 33146-2435 - Phone
- (305) 284-4535
- Fax
- (305) 284-6128
- NPI assigned
- Nov 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | PT 7485 | FL | Primary |
Addresses
Primary practice location
5915 Ponce de Leon Blvd
Plumer BLDG.,5TH Floor
Coral Gables, FL 33146-2435
Mailing address
5915 Ponce de Leon Blvd
Plumer BLDG.,5TH Floor
Coral Gables, FL 33146-2435
Phone (305) 284-4535
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 |
|---|---|---|---|
| PT 7485 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1205018710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5915 PONCE DE LEON BLVD",
"address_2": "PLUMER BLDG.,5TH FLOOR",
"city": "CORAL GABLES",
"state": "FL",
"postal_code": "331462435",
"telephone_number": "305-284-4535",
"fax_number": "305-284-6128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5915 PONCE DE LEON BLVD",
"address_2": "PLUMER BLDG.,5TH FLOOR",
"city": "CORAL GABLES",
"state": "FL",
"postal_code": "331462435",
"telephone_number": "305-284-4535",
"fax_number": "305-284-6128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "PHILLIP",
"middle_name": "RAY",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-27",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 7485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coral Gables, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.