Krista Wagenknecht

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

LPT30393 Issued in AZ

Practice address

6399 Hitt Rd
Milledgeville, IL 61051-9379

Phone

(815) 718-4686

NPI assigned

May 30, 2019

Last updated

Jun 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Broad River RehabilitationGroup PAC ID 3375801350, 210 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Broad River Rehabilitation

  dba Broad River Rehab

  • Occupational Therapist
  • Charlotte, NC
  • NPI 1902317589

  GA, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Dawsonville, GA
  • NPI 1528419751
  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1518525047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6399 HITT RD",
            "city": "MILLEDGEVILLE",
            "state": "IL",
            "postal_code": "610519379",
            "telephone_number": "815-718-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6399 HITT RD",
            "city": "MILLEDGEVILLE",
            "state": "IL",
            "postal_code": "610519379",
            "telephone_number": "815-718-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENKNECHT",
        "first_name": "KRISTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070020452",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT30393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Leech Counseling, LLC
• Milledgeville Fire Protection District
• Brooke Olberding, DC
• Vernon Michael Stewart, CRNA
• Angela M Stralow, NP

• Physical Therapist in Milledgeville, IL
• Providers in Milledgeville, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.