Active NPI
Heidi Annette Wagonhauser, LMT
- Massage Therapist
- Great Falls, MT
National Provider Identifier
1720366123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 634
- Practice address
- 1400 29TH St S FL 2
Great Falls, MT 59405-5353 - Phone
- (406) 761-3767
- Fax
- (406) 761-3038
- NPI assigned
- Aug 2, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 634 | MT | Primary |
Addresses
Primary practice location
1400 29TH St S FL 2
Great Falls, MT 59405-5353
Mailing address
1400 29TH St S FL 2
Great Falls, MT 59405-5353
Phone (406) 761-3767
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 634 | MT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Medical Rehabilitation Services, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Medicine & Rehabilitation Physician
- Great Falls, MT
- NPI 1174711360
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1720366123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 29TH ST S FL 2",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594055353",
"telephone_number": "406-761-3767",
"fax_number": "406-761-3038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 29TH ST S FL 2",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594055353",
"telephone_number": "406-761-3767",
"fax_number": "406-761-3038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONHAUSER",
"first_name": "HEIDI",
"middle_name": "ANNETTE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-02",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MT",
"license": "634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.