Individual provider Active NPI

Daya Wagh, DPT

  • Physical Therapist
  • Portage, MI
National Provider Identifier
1669154761
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5502008437 Issued in MI
Practice address
1423 W Centre Ave
Portage, MI 49024-5323
Phone
(269) 323-4300
Fax
(269) 323-4449
NPI assigned
Aug 7, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5502008437 MI Primary

Addresses

Primary practice location

1423 W Centre Ave
Portage, MI 49024-5323

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230809003993 MI Practitioner - Physical Therapist in Private Practice 1355703208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Michigan LLCGroup PAC ID 6901165893, 156 clinicians

Practice addresses (Care Compare)

5460 Gull Rd
Suite E
Kalamazoo, MI 49048-7653
Phone (269) 238-5044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5502008437MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Michigan, LLC Physical Therapist CurrentSince Aug 7, 2023 Accepting new patients
Physical Therapy One, P.C. Physical Therapist PastSince Aug 7, 2023 Accepting new patients
Ivyrehab Northern PT, LLC Past Accepting new patients

Locations

3282 Stadium Dr
Kalamazoo, MI 49008
Phone (269) 375-1400

6947 W Q Ave
Kalamazoo, MI 49009
Phone (269) 447-1560

5460 Gull Rd
Ste E
Kalamazoo, MI 49048
Phone (269) 238-5044

135 S Milford Rd
Milford, MI 48381
Phone (248) 685-7272

1764 S Ortonville Rd
Ortonville, MI 48462
Phone (248) 793-5730

1764 S Ortonville Rd
Ste 400
Ortonville, MI 48462
Phone (248) 793-5730

1423 W Centre Ave
Portage, MI 49024
Phone (269) 323-4300

737 S US Highway 131
Three Rivers, MI 49093
Phone (269) 256-5595

13329 Portage Rd
Vicksburg, MI 49097
Phone (269) 649-2400

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1669154761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245323",
            "telephone_number": "269-323-4300",
            "fax_number": "269-323-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGH",
        "first_name": "DAYA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-07",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5502008437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.