Gina L Wagner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1105294 Issued in TX

Practice address

4135 S Broadway Ave
Tyler, TX 75701-8720

Phone

(713) 297-7000

Fax

(713) 297-7090

NPI assigned

Dec 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Performancepro Sports Medicine and Rehabilitation

  • Durable Medical Equipment & Medical Supplies
  • Tyler, TX
  • NPI 1063663227
  NPD (past)
• Performancepro Sports Medicine and Rehabilitation Limited Partnership

  • Physical Therapist
  • Tyler, TX
  • NPI 1740464387
  NPD (past)

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198022400000",
    "number": "1447434980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018720",
            "telephone_number": "713-297-7000",
            "fax_number": "713-297-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018720",
            "telephone_number": "713-297-7000",
            "fax_number": "713-297-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GINA",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1105294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Renae' Wade, NP-C
• Roy Brent Wadle, D.O.
• Shelby Young Wager, RD
• Rebecca S Waggoner, NP
• Brittany Wagner, MD
• Kelsey Wagner
• Demeshia Wagoner
• Lanna Waithe
• Kathleen Wakefield, LMSW-ACP
• Wal-Mart Stores Texas LLC

• Physical Therapist in Tyler, TX
• Providers in Tyler, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.