Active NPI
Michael Wagaman
- Sports Physical Therapist
- Grapevine, TX
National Provider Identifier
1780378596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- License
- 3131281
- Practice address
- 529 Industrial Blvd Ste 101
Grapevine, TX 76051-8609 - Phone
- (817) 313-2988
- NPI assigned
- Jun 5, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | 3131281 | TX | Primary |
Addresses
Primary practice location
529 Industrial Blvd Ste 101
Grapevine, TX 76051-8609
Mailing address
529 Industrial Blvd Ste 101
Grapevine, TX 76051-8609
Phone (817) 313-2988
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 |
|---|---|---|---|
| 3131281 | TX | MD | Sports Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685923200000",
"number": "1780378596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "529 INDUSTRIAL BLVD STE 101",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "760518609",
"telephone_number": "817-313-2988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "529 INDUSTRIAL BLVD STE 101",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "760518609",
"telephone_number": "817-313-2988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGAMAN",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-05",
"last_updated": "2023-06-05",
"certification_date": "2023-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "TX",
"license": "3131281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grapevine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.