Blair Ellen Wagoner

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT005412 Issued in KY

Practice address

1001 Monarch St
Suite 110
Lexington, KY 40513-1495

Phone

(859) 224-0834

NPI assigned

Apr 28, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270771200000",
    "number": "1891939344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 WEST DR",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420719830",
            "telephone_number": "270-293-0758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MONARCH ST",
            "address_2": "SUITE 110",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131495",
            "telephone_number": "859-224-0834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "BLAIR",
        "middle_name": "ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-28",
        "last_updated": "2010-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT 3141",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "KY",
            "license": "PT005412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marsha Winkler Wagner I, OT
• Mary Wagner, OT
• Maxwell Joseph Wagner, MD
• Melissa Kay Wagner, LPCA
• Miriam Denise Wagner
• Rebekah Wahking, PHARMD, MBA
• John Philip Wahle III, DMD
• Thomas Henry Waid, MD
• Rebekah Lynne Waikel, PHD, CGC
• Donald Wainscott II, PA-C

• Pediatric Physical Therapist in Lexington, KY
• Providers in Lexington, KY by specialty
• Pediatric Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2010; 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.