Judith Wagner

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501002691 Issued in MI

Practice address

23161 Greater Mack Ave
Saint Clair Shores, MI 48080-1956

Phone

(586) 779-8892

Fax

(586) 779-2869

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

Yes

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 MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leelanau Physical Therapy PCGroup PAC ID 1557527561, 16 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 and National Provider Directory roles.

• Leelanau Physical Therapy, PC

  • Physical Therapist
  • Suttons Bay, MI
  • NPI 1295092658
  Medicare reassignment Care Compare group NPD
• David Gilboe & Associates, Inc.

  • Customized Equipment (DME)
  • Saint Clair Shores, MI
  • NPI 1023227857
  NPD (past)
• David Gilboe and Associates Inc

  • Physical Therapist
  • St Clair Shores, MI
  • NPI 1558458802
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659458016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23161 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801956",
            "telephone_number": "586-779-8892",
            "fax_number": "586-779-2869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23161 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801956",
            "telephone_number": "586-779-8892",
            "fax_number": "586-779-2869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JUDITH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501002691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daljit Virdi, RPH
• Van Chau Hong Vo, M.D.
• John Vollmer, PA-C
• William James Vornberger, MD
• Lamthy Quoc Vu, RPH
• Kandy Kay Wagner, M.T.
• Paul Steven Wainess, DDS
• Jehan Wakeem, DDS
• Walgreen Co
• Walgreen Co

• Physical Therapist in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.