Active NPI
Jane Paula Wagner, MSPT, PCS
- Pediatric Physical Therapist
- Irving, TX
National Provider Identifier
1518273358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1025898
- Practice address
- 304 Pecos TRL
Irving, TX 75063-4541 - Phone
- (214) 405-2394
- NPI assigned
- Aug 30, 2010
- Last updated
- Aug 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1025898 | TX | Primary |
Addresses
Primary practice location
304 Pecos TRL
Irving, TX 75063-4541
Mailing address
304 Pecos TRL
Irving, TX 75063-4541
Phone (214) 405-2394
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 |
|---|---|---|---|
| 1025898 | TX | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283126400000",
"number": "1518273358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 PECOS TRL",
"city": "IRVING",
"state": "TX",
"postal_code": "750634541",
"telephone_number": "214-405-2394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 PECOS TRL",
"city": "IRVING",
"state": "TX",
"postal_code": "750634541",
"telephone_number": "214-405-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JANE",
"middle_name": "PAULA",
"credential": "MSPT, PCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-30",
"last_updated": "2010-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "1025898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.