Active NPI
Amy E Wagner, P.T.
- Physical Therapist
- Alhambra, CA
National Provider Identifier
1710033097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 25461
- Practice address
- 1428 S Marengo Ave
Alhambra, CA 91803-3001 - Phone
- (626) 576-1032
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 25461 | CA | Primary |
Addresses
Primary practice location
1428 S Marengo Ave
Alhambra, CA 91803-3001
Mailing address
626 N Monterey St
Apt. L
Alhambra, CA 91801-1596
Phone (626) 394-9673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25461 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185235200000",
"number": "1710033097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 N MONTEREY ST",
"address_2": "APT. L",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918011596",
"telephone_number": "626-394-9673",
"fax_number": "626-293-3370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1428 S MARENGO AVE",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918033001",
"telephone_number": "626-576-1032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "AMY",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "25461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alhambra, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.