Holly M Wagner, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25502 Issued in CA

Practice address

1178 N Tustin St
Orange, CA 92867-6006

Phone

(714) 289-7790

Fax

(714) 289-7786

NPI assigned

Mar 14, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Milan Physical Therapy & Associates Inc.

  • Physical Therapist
  • Orange, CA
  • NPI 1073885935
  NPD (past)

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285767350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1178 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928676006",
            "telephone_number": "714-289-7790",
            "fax_number": "714-289-7786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1178 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928676006",
            "telephone_number": "714-289-7790",
            "fax_number": "714-289-7786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "HOLLY",
        "middle_name": "M",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "25502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE TWO NPI",
            "identifier": "1154327922",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daesean Leron Wade
• Sioban Wade
• Tynesha Wade, CPNP-AC
• Christian Alexander Waer
• Feizal Waffarn, MD
• Shatha Wahbi
• Michelle Linne Wahlquist, M.S. CCC-SLP
• Sophia Wainscott
• Erin Wainwright, MD
• Heather Waite

• Physical Therapist in Orange, CA
• Providers in Orange, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.