Active NPI
Steven Michael Bagwell, DPT
- Physical Therapist
- Fullerton, CA
National Provider Identifier
1366849713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 41946
- Practice address
- 1027 N Harbor Blvd Ste B
Fullerton, CA 92832-1310 - Phone
- (714) 870-8478
- NPI assigned
- Dec 1, 2014
- 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 | 41946 | CA | Primary |
Addresses
Primary practice location
1027 N Harbor Blvd Ste B
Fullerton, CA 92832-1310
Mailing address
2285 Rose Ave Apt C
Signal Hill, CA 90755-3724
Phone (909) 938-0719
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 |
|---|---|---|---|
| 41946 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418860800000",
"number": "1366849713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2285 ROSE AVE APT C",
"city": "SIGNAL HILL",
"state": "CA",
"postal_code": "907553724",
"telephone_number": "909-938-0719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1027 N HARBOR BLVD STE B",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928321310",
"telephone_number": "714-870-8478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGWELL",
"first_name": "STEVEN",
"middle_name": "MICHAEL",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-01",
"last_updated": "2014-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "41946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.