Active NPI
Colleen M Wagar, PT
- Physical Therapist
- Huntersville, NC
National Provider Identifier
1386659902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8451
- Practice address
- 16455 Statesville Rd
Suite 300
Huntersville, NC 28078-7135 - Phone
- (704) 801-3719
- Fax
- (704) 801-3705
- NPI assigned
- Jul 30, 2006
- 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 | 8451 | NC | Primary |
Addresses
Primary practice location
16455 Statesville Rd
Suite 300
Huntersville, NC 28078-7135
Mailing address
1691 Old Harmony Dr NW
Concord, NC 28027-8031
Phone (704) 674-9346
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7211860 | Medicaid | NC | |
| E1251 | Other | NC | MEDCOST NC |
| 079PU | Other | NC | BCBS NC |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13335 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252540800000",
"number": "1386659902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1691 OLD HARMONY DR NW",
"city": "CONCORD",
"state": "NC",
"postal_code": "280278031",
"telephone_number": "704-674-9346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16455 STATESVILLE RD",
"address_2": "SUITE 300",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280787135",
"telephone_number": "704-801-3719",
"fax_number": "704-801-3705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGAR",
"first_name": "COLLEEN",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-30",
"last_updated": "2009-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "8451",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7211860",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST NC",
"identifier": "E1251",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "079PU",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.