Kyle J Wagner, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070022159 Issued in IL

Practice address

1323 W Diversey Pkwy
Chicago, IL 60614-1207

Phone

(773) 549-2520

Fax

(773) 549-2743

NPI assigned

Aug 21, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Progress Physical Therapy LLCGroup PAC ID 1951530849, 430 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Progress Physical Therapy LLC

  • Physical Therapist
  • Philadelphia, PA
  • NPI 1164851085
  Medicare reassignment Care Compare group NPD
• Mobility Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Downingtown, PA
  • NPI 1932872793

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465171200000",
    "number": "1386078731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-6200",
            "fax_number": "630-928-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1323 W DIVERSEY PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141207",
            "telephone_number": "773-549-2520",
            "fax_number": "773-549-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KYLE",
        "middle_name": "J",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-21",
        "last_updated": "2016-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT022891",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070022159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara Wagner
• Katharine Kuball Wagner, LCSW
• Katherine Louise Wagner, PA-C
• Kelly Ann Wagner, RD
• Kinga Wagner, LCPC
• Lauren E Wagner, M.D.
• Lindsay Wagner, CRNA
• Lisa Wagner
• Lynne I. Wagner, PH.D.
• Mary Kathleen Wagner, LCSW CADC

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.