Elizabeth Hansen Wagner, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

08371 Issued in LA

Practice address

266 Ockley Dr
Shreveport, LA 71105-3025

Phone

(318) 868-3268

Fax

(318) 861-2714

NPI assigned

Mar 4, 2014

Last updated

Mar 17, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Studio P3 LLCGroup PAC ID 6507085099, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Studio P3, LLC

  • Physical Therapist
  • Shreveport, LA
  • NPI 1215353115
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1295150977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 OCKLEY DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711053025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 OCKLEY DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711053025",
            "telephone_number": "318-868-3268",
            "fax_number": "318-861-2714"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2539 E.70th St.",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "71105",
            "country_code": "US",
            "telephone_number": "318-364-7741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELIZABETH",
        "middle_name": "HANSEN",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-04",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "08371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Michael Wages Jr., M.D.
• Gabrielle Renee Waggoner
• Sharon Waggoner, MSW
• Catherine C Wagner, CRNA
• Diane Brown Wagner, MD
• John Wagner, M.D.
• Sarah Wagner
• Hillary Wagnon
• Lauren Wagnon, PLPC
• Tyler Wagnon, HIS

• Physical Therapist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.