Active NPI
Garth Wagenman, PT
- Specialist
- Flagstaff, AZ
National Provider Identifier
1952599284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 7849
- Practice address
- 125 E Elm Ave
Ste 103
Flagstaff, AZ 86001-3258 - Phone
- (928) 779-1679
- Fax
- (928) 779-2822
- NPI assigned
- Oct 11, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 7849 | AZ | Primary |
Addresses
Primary practice location
125 E Elm Ave
Ste 103
Flagstaff, AZ 86001-3258
Mailing address
125 E Elm Ave
Ste 103
Flagstaff, AZ 86001-3258
Phone (928) 779-1679
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 |
|---|---|---|---|
| 7849 | AZ | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northland-Rural Therapy Associates, LLC | Specialist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Northland-Rural Therapy Associates
- Specialist
- Flagstaff, AZ
- NPI 1376677914
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192060800000",
"number": "1952599284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E ELM AVE",
"address_2": "STE 103",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013258",
"telephone_number": "928-779-1679",
"fax_number": "928-779-2822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 E ELM AVE",
"address_2": "STE 103",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013258",
"telephone_number": "928-779-1679",
"fax_number": "928-779-2822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENMAN",
"first_name": "GARTH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-11",
"last_updated": "2007-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "7849",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.