Carolyn Wagner, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1176-19 Issued in WI

Practice address

1130 N Westfield St
Oshkosh, WI 54902-3217

Phone

(920) 237-2163

NPI assigned

Aug 6, 2008

Last updated

Aug 6, 2008By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217980800000",
    "number": "1306002506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 N WESTFIELD ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549023217",
            "telephone_number": "920-237-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 N WESTFIELD ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549023217",
            "telephone_number": "920-237-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CAROLYN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-06",
        "last_updated": "2008-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1176-19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40460700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amos Voung, RBT
• Janet Susan Vroman, RN
• Vin X Vu, DDS
• Angela Marie Wade, M.S.
• Lanelle R Waech, RN
• Kathryn L Wagner, RN
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1430)
• Wal-Mart Stores East, LP (Vision Center 30-1430)
• Rebecca L Waldman, MD
• Kurt A Walejko, D.D.S.

• Physical Therapy Assistant in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.