Active NPI
Patricia Wagner
- Physical Therapist
- Waltham, MA
National Provider Identifier
1376220830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTL10777
- Practice address
- 303 Wyman St Ste 300
Waltham, MA 02451-1255 - Phone
- (877) 407-3422
- Fax
- (877) 407-4329
- NPI assigned
- Jun 28, 2023
- Sex
- Female
- 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 | PTL10777 | MA | Primary |
Addresses
Primary practice location
303 Wyman St Ste 300
Waltham, MA 02451-1255
Mailing address
7 Carnegie PLZ
Cherry Hill, NJ 08003-1000
Phone (877) 407-3422
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 |
|---|---|---|---|
| PTL10777 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687910400000",
"number": "1376220830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 CARNEGIE PLZ",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080031000",
"telephone_number": "877-407-3422",
"fax_number": "877-407-4329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 WYMAN ST STE 300",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511255",
"telephone_number": "877-407-3422",
"fax_number": "877-407-4329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "PATRICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-28",
"last_updated": "2023-06-28",
"certification_date": "2023-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "PTL10777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.