Active NPI
Derek Wagner, DPT
- Physical Therapist
- New Castle, DE
National Provider Identifier
1487828570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA01275800
- Practice address
- 2032 New Castle Ave
New Castle, DE 19720-7703 - Phone
- (302) 654-1700
- NPI assigned
- Apr 18, 2008
- Sex
- Male
- 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 | 40QA01275800 | NJ | Primary |
Addresses
Primary practice location
2032 New Castle Ave
New Castle, DE 19720-7703
Mailing address
1812 Marsh Rd
Store 505
Wilmington, DE 19810-4581
Phone (302) 793-0432
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 126199DBD | Other | NJ | MEDICARE |
| P01013263 | Other | MD | MCRR |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ati Holdings, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba ATI Physical Therapy
- Physical Therapy Clinic/Center
- Rising Sun, MD
- NPI 1396781050
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335398400000",
"number": "1487828570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1812 MARSH RD",
"address_2": "STORE 505",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198104581",
"telephone_number": "302-793-0432",
"fax_number": "302-793-0400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2032 NEW CASTLE AVE",
"city": "NEW CASTLE",
"state": "DE",
"postal_code": "197207703",
"telephone_number": "302-654-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DEREK",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-18",
"last_updated": "2012-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01275800",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "126199DBD",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCRR",
"identifier": "P01013263",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Castle, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.