Kevin Matthew Wagner, MD PT CERT MDT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

115026 Issued in MO

Practice address

11903 Saint Charles Rock Rd
Bridgeton, MO 63044-2623

Phone

(314) 770-0900

Fax

(314) 770-1673

NPI assigned

Jul 22, 2005

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272499200000",
    "number": "1295735926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BACK PAIN INSTITUTE OF ST. LOUIS LLC",
            "address_2": "11903 ST. CHARLES ROCK RD.",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-770-0900",
            "fax_number": "314-739-8569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11903 SAINT CHARLES ROCK RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442623",
            "telephone_number": "314-770-0900",
            "fax_number": "314-770-1673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KEVIN",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "MD PT CERT MDT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2010-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "115026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VRD Radiation Oncology, PC
• Zoe Marie Wadsworth, APRN-CPNP
• Colleen Wagener
• Nikita Wagle, MD
• Julia Wagner, FNP-C
• M Safwat Wahba, M.D.
• Andrew J Wahle, PA
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Jessica Renee Waldrop, B.A.

• Physical Therapist in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; 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.