Active NPI
Andrew Blake Wagner, PT
- Physical Therapist
- Yorktown, IN
National Provider Identifier
1306802087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05007376A
- Practice address
- 7701 West Kilgore
Ste 1a
Yorktown, IN 47396 - Phone
- (765) 759-5273
- Fax
- (765) 759-5519
- NPI assigned
- Apr 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05007376A | IN | Primary |
Addresses
Primary practice location
7701 West Kilgore
Ste 1a
Yorktown, IN 47396
Mailing address
10657 W 200 S
Parker City, IN 47368
Phone (765) 468-7297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05007376A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1306802087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10657 W 200 S",
"city": "PARKER CITY",
"state": "IN",
"postal_code": "47368",
"telephone_number": "765-468-7297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7701 WEST KILGORE",
"address_2": "STE 1A",
"city": "YORKTOWN",
"state": "IN",
"postal_code": "47396",
"telephone_number": "765-759-5273",
"fax_number": "765-759-5519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ANDREW",
"middle_name": "BLAKE",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-22",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05007376A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yorktown, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.