Barbara Reddien Wagner, PT, DPT, MHA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT002631E Issued in PA

Practice address

6 Covington Lake Est
Gouldsboro, PA 18424-9433

Phone

(570) 941-7936

NPI assigned

May 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831306745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 COVINGTON LAKE EST",
            "city": "GOULDSBORO",
            "state": "PA",
            "postal_code": "184249433",
            "telephone_number": "570-941-7936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 COVINGTON LAKE EST",
            "city": "GOULDSBORO",
            "state": "PA",
            "postal_code": "184249433",
            "telephone_number": "570-941-7936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BARBARA",
        "middle_name": "REDDIEN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, MHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT002631E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane M. M. Dellavalle, PHD, RDN, LDN
• Gouldsboro Ambulance Squad Inc
• Keystone Community Resources, Inc.
• Keystone Community Resources, Inc.
• Krystal Koru Lynn-Tolson, LPC
• Alyssa Nicole Woods, MA, LPC, CAADC

• Physical Therapist in Gouldsboro, PA
• Providers in Gouldsboro, PA by specialty
• Physical Therapist in Pennsylvania

• 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.

Verify at the official NPI Registry.