Active NPI
Robert Wagner
- Physical Therapist
- Plains, PA
National Provider Identifier
1740176023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT032084
- Practice address
- 667 S River St
Plains, PA 18705-1013 - Phone
- (570) 825-7676
- NPI assigned
- Jun 14, 2025
- Sex
- Unspecified or another gender identity
- 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 | PT032084 | PA | Primary |
Addresses
Primary practice location
667 S River St
Plains, PA 18705-1013
Mailing address
111 Elmcrest Dr
Dallas, PA 18612-9166
Phone (856) 472-8996
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 |
|---|---|---|---|
| PT032084 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750204800000",
"number": "1740176023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 ELMCREST DR",
"city": "DALLAS",
"state": "PA",
"postal_code": "186129166",
"telephone_number": "856-472-8996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "667 S RIVER ST",
"city": "PLAINS",
"state": "PA",
"postal_code": "187051013",
"telephone_number": "570-825-7676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-06-14",
"last_updated": "2025-06-18",
"certification_date": "2025-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT032084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plains, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.