Amy Linn Wagamon, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

09785 Issued in OR

Practice address

5701 SW Multnomah Blvd
Portland, OR 97219-3195

Phone

(503) 244-1107

NPI assigned

Jul 31, 2019

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1669026274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE STE D",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697",
            "telephone_number": "971-224-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 SW MULTNOMAH BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972193195",
            "telephone_number": "503-244-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGAMON",
        "first_name": "AMY",
        "middle_name": "LINN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "09785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keenan Wadnizak
• Elena Wadsworth
• John G Wadsworth, LCSW
• Elizabeth Waechter Smith, CADC I
• Patricia Wafer
• Shelly Wagar, LAC
• Paula Wagenbach, PSYD
• Karen A Wager, D.C.
• Melissa J Wages, DDS
• Haley Waggoner

• Physical Therapy Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physical Therapy Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.