Dylan Kurt Wagner, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PTL0020298 Issued in CO

Practice address

2150 Stadium Drive 2ND Floor
Boulder, CO 80309-0001

Phone

(303) 315-9900

NPI assigned

Dec 24, 2024

Sex

Male

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

Enrolled in CO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Boulder Community Health

  • General Acute Care Hospital
  • Boulder, CO
  • NPI 1821074196
  Medicare reassignment Care Compare group NPD
• Boulder Community Health

  • Medical Specialty Clinic/Center
  • Boulder, CO
  • NPI 1083261671
  NPD
• Boulder Community Health

  • Primary Care Clinic/Center
  • Boulder, CO
  • NPI 1740837137
  NPD
• Boulder Community Health

  • Medical Specialty Clinic/Center
  • Boulder, CO
  • NPI 1407685498
  NPD (past)
• Boulder Community Health

  • Multi-Specialty Clinic/Center
  • Boulder, CO
  • NPI 1609822030
  NPD (past)

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

{
    "created_epoch": "1734998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734998400000",
    "number": "1831907708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3553 N FILLMORE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802054259",
            "telephone_number": "321-412-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 STADIUM DRIVE 2ND FLOOR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803090001",
            "telephone_number": "303-315-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DYLAN",
        "middle_name": "KURT",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-24",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CO",
            "license": "PTL0020298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darcy Wade, MA, LPCC
• Patricia M Wade, CCC-SLP
• Dawn Carlisle Wadsworth, MS, BCBA,
• Cherlyn Wager, B.A.
• Justina Pittman Wagers, PSY.D.
• John M. Wagner, M.S.
• Jonathan Stuart Wagner, LPCC
• Kristin M Wagner, M.A., L.P.C., N.C.C.
• Matthew Wagner, P.T.
• Jamal Waire, PSYD

• Orthopedic Physical Therapist in Boulder, CO
• Providers in Boulder, CO by specialty
• Orthopedic Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.