Justin Roman Wagner, PT

Primary specialty

SpecialistTaxonomy code 174400000X

License

03670 Issued in IA

Practice address

Rec Center Physical Therapy
400 Collins Rd NE 154-100
Cedar Rapids, IA 52498-0001

Phone

(319) 295-8899

Fax

(319) 295-8833

NPI assigned

Jan 10, 2006

Last updated

Oct 2, 2013By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Match Play Tennis Centers IncGroup PAC ID 0042262008, 13 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Match Play Tennis Centers, Inc.

  dba Rec Center Physical Therapy

  • Physical Therapy Clinic/Center
  • Cedar Rapids, IA
  • NPI 1760540926
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380672000000",
    "number": "1669451472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "REC CENTER PHYSICAL THERAPY",
            "address_2": "400 COLLINS RD NE 154-100",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524980001",
            "telephone_number": "319-295-8899",
            "fax_number": "319-295-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "REC CENTER PHYSICAL THERAPY",
            "address_2": "400 COLLINS RD NE 154-100",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524980001",
            "telephone_number": "319-295-8899",
            "fax_number": "319-295-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JUSTIN",
        "middle_name": "ROMAN",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2013-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "03670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK PROVIDER NUMBER",
            "identifier": "38070",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ankur Vyas, M.B., B.S.
• Cason William Wacker, PHARM. D.
• Takia Wade-Springer, COTA/L
• Hisham Wagdy, MD
• Cassandra Wagner, DPT
• Paige Marie Wagner
• Steven Mark Wahle, MD
• Wal-Mart Stores, Inc. (Vision Center 30-2716)
• Wal-Mart Stores, Inc. (Vision Center 30-1528)
• Dale L. Waldner, M.D.

• Specialist in Cedar Rapids, IA
• Providers in Cedar Rapids, IA by specialty
• Specialist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; 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.