Kaelyn Wagner, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

17294-24 Issued in WI

Practice address

W3124 Van Roy Rd
Appleton, WI 54915-3929

Phone

(920) 968-1010

Fax

(920) 968-1012

NPI assigned

Jun 2, 2025

Sex

Unspecified or another gender identity

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

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Physical Therapy and Sports Medicine SCGroup PAC ID 2365432903, 62 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations (25 of 27)

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.

• Advanced Physical Therapy & Sports Medicine SC

  • Physical Medicine & Rehabilitation Physician
  • Appleton, WI
  • NPI 1407857790

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Advanced Physical Therapy & Sports Medicine SC

  • Durable Medical Equipment & Medical Supplies
  • Grand Chute, WI
  • NPI 1538858857

  Physical Therapist

  NPD

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

{
    "created_epoch": "1748822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1265325849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE STE 113",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-991-2561",
            "fax_number": "920-991-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3124 VAN ROY RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549153929",
            "telephone_number": "920-968-1010",
            "fax_number": "920-968-1012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 W Kennedy Ave",
            "address_purpose": "LOCATION",
            "city": "Kimberly",
            "state": "WI",
            "postal_code": "541362836",
            "country_code": "US",
            "telephone_number": "920-991-2561",
            "fax_number": "920-991-2563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KAELYN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2025-06-02",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "17294-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wagner Family Chiropractic SC
• Wagner Wellness LLC
• Christopher T Wagner, MD
• Courtney Lynn Wagner, LAT, ATC
• Jody Michelle Wagner, D.C.
• Keith Dineen Wagner, M.D.
• Michael Ryan Wagner, D.C.
• Ryan J Wagner
• Timothy John Wagner, D.C., B.S.
• Wal-Mart Stores Easst, LP

• Physical Therapist in Appleton, WI
• Providers in Appleton, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.