Rebecca Wagner, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-4365 Issued in ID

Practice address

1460 Elk Creek Dr
Idaho Falls, ID 83404-8237

Phone

(208) 535-1286

Fax

(208) 535-1291

NPI assigned

Aug 28, 2009

Last updated

Mar 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  NPD (past)
• Speech and Language Clinic, Inc

  • Speech-Language Pathologist
  • Ammon, ID
  • NPI 1891953519
  NPD (past)
• Langford Consulting Incorporated

  dba Langford Sports & Physical Therapy

  • Physical Therapist
  • Albuquerque, NM
  • NPI 1225070634
  NPD (past)

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

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1447483029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048237",
            "telephone_number": "208-535-1286",
            "fax_number": "208-535-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048237",
            "telephone_number": "208-535-1286",
            "fax_number": "208-535-1291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2972 Escalante Ave",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047266",
            "country_code": "US",
            "telephone_number": "505-228-4690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "REBECCA",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-28",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "3742",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-4365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jarica Wadsworth, RN
• Peter J Wadsworth, BA
• Charles Allen Wagner, DDS
• Margaret A Wagner, M.D.
• Niki Wagner
• Robert Wagner, MD
• Dylan Wake, M.S. CCC-SLP
• Wal-Mart Stores, Inc (Vision Center 30-5494)
• Paul Debarton Walbom, RPH
• Elda Jannae Walden, M.S.

• Physical Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.