Cameron Waggoner, PT, DPT, NCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305212507 Issued in VA

Practice address

400 Madison St Apt 1406
Alexandria, VA 22314-1724

Phone

(901) 288-8062

NPI assigned

Oct 22, 2018

Sex

Male

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

Enrolled in DC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Group practices

Goodwin House Home and Community Based ServicesGroup PAC ID 7214366244, 15 clinicians

Practice addresses (Care Compare)

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.

• Goodwin House Home and Community Based Services

  • Multi-Specialty Clinic/Center
  • Alexandria, VA
  • NPI 1144969296

  DC, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Nova Neuro Rehab PLLC

  • Physical Therapist
  • Alexandria, VA
  • NPI 1518707322
  NPD Authorized official

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1639645245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25451",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223135451",
            "telephone_number": "901-288-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MADISON ST APT 1406",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223141724",
            "telephone_number": "901-288-8062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "CAMERON",
        "credential": "PT, DPT, NCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-22",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305212507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Wade
• Karima Wade
• Larren Wade, MD
• Tina Wade
• Evelyn Cecilia Wadsworth, LCSW
• Jeffrey David Wagman, D.D.S.
• Wagner Autism Growth LLC
• Kaitlynn Nicole Wagner, CCC-SLP
• Margaret Mary-Rose Wagner
• Megan Elizabeth Wagner, LBA, BCBA

• Physical Therapist in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.