Teresa Michelle Wagner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT16007 Issued in FL

Practice address

807 N Tyndall Pkwy
Panama City, FL 32404-9495

Phone

(850) 763-0505

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Rehabcare Group East, LLC

  • Rehabilitation Clinic/Center
  • Shalimar, FL
  • NPI 1407382278
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1255487286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 SOUTH BLVD",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324281624",
            "telephone_number": "850-638-3075",
            "fax_number": "850-415-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 N TYNDALL PKWY",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324049495",
            "telephone_number": "850-763-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TERESA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT16007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y8622",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anh P Vu
• Ducthanh N Vu, MD
• Huan Minh Vu, M.D.
• Tien Vu, PHARMACIST
• Ashok Kumar Wadhera, M.D.
• Abdul Waheed, DMD
• Brenda Ann Wainwright, O.D.
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP

• Physical Therapist in Panama City, FL
• Providers in Panama City, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.

Verify at the official NPI Registry.