Active NPI
Mary Jo Anne Wagner, MARY JO WAGNER P.T.
- Physical Therapist
- Saint Louis, MO
National Provider Identifier
1750599841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01942
- Practice address
- 9717 Landmark Parkway Dr
#216
Saint Louis, MO 63127-1628 - Phone
- (314) 849-4120
- Fax
- (314) 849-2540
- NPI assigned
- May 20, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 01942 | MO | Primary |
Addresses
Primary practice location
9717 Landmark Parkway Dr
#216
Saint Louis, MO 63127-1628
Mailing address
1518 State Route 156
Waterloo, IL 62298-6104
Phone (618) 935-2323
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 |
|---|---|---|---|
| 01942 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750599841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1518 STATE ROUTE 156",
"city": "WATERLOO",
"state": "IL",
"postal_code": "622986104",
"telephone_number": "618-935-2323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9717 LANDMARK PARKWAY DR",
"address_2": "#216",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631271628",
"telephone_number": "314-849-4120",
"fax_number": "314-849-2540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "MARY JO",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "MARY JO WAGNER P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "01942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.