Trever Wagner, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1898 Issued in SD

Practice address

1110 W Omaha St
# 3
Rapid City, SD 57701-8120

Phone

(605) 721-5950

NPI assigned

Jun 7, 2016

Last updated

Jun 7, 2016By the provider in NPPES

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 SD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physiolife 605 PLLCGroup PAC ID 3476907577, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Physiolife 605 PLLC

  • Physical Therapy Clinic/Center
  • Harrisburg, SD
  • NPI 1396433629

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official
• Advanced Health Care Solutions of the Northern Hills, Prof. LLC

  • Chiropractor
  • Rapid City, SD
  • NPI 1851492284
  Medicare reassignment NPD
• Rapid City Physical Therapy, Inc

  dba The Physical Therapy Center

  • Physical Therapy Clinic/Center
  • Rapid City, SD
  • NPI 1740398833
  Medicare reassignment NPD

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1649629080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6855 DAISY DR",
            "city": "BLACK HAWK",
            "state": "SD",
            "postal_code": "577188202",
            "telephone_number": "605-770-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W OMAHA ST",
            "address_2": "# 3",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577018120",
            "telephone_number": "605-721-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TREVER",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "1898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kierstan Marie Wadsworth, PT, DPT
• Ashley Lynn Wagner, CNP
• Dustin R Wagner
• Jessica Ann Wagner, RN
• Jobie Wagner
• Jeff Wahl
• Wal-Mart Stores Inc (Wal-Mart Vision Center 30-3872)
• Mia Wald
• Tim Wald
• James S Walder, MD

• Physical Therapist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Physical Therapist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; 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.