Scott Wagner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4604 Issued in MN

Practice address

3015 Utah Ave S
Suite 200
Saint Louis Park, MN 55426-3671

Phone

(952) 933-1121

Fax

(952) 945-9635

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Life Medical PAGroup PAC ID 6204938350, 8 clinicians

Minnesota Medical and Rehabilitative Services LLCGroup PAC ID 6406764703, 8 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.

• Minnesota Medical and Rehabilitative Services, LLC

  • Physical Therapist
  • St. Louis Park, MN
  • NPI 1154302545
  Medicare reassignment Care Compare group NPD
• Life Medical, P.a.

  • Multi-Specialty Clinic/Center
  • Saint Louis Park, MN
  • NPI 1740222496
  Medicare reassignment Care Compare group
• Primary Care & Rehabilitation Clinics, Inc.

  • Multi-Specialty Clinic/Center
  • St Louis Park, MN
  • NPI 1306842547
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1982648051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 UTAH AVE S",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554263671",
            "telephone_number": "952-933-1121",
            "fax_number": "952-945-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 UTAH AVE S",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554263671",
            "telephone_number": "952-933-1121",
            "fax_number": "952-945-9635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "4604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHP",
            "identifier": "4604",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HP",
            "identifier": "HP46100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Wagner, PSYD
• Gina M Wagner, DPT
• Julie Ann Wagner, NP
• Mary D Wagner
• Sara Ellen Wagner, LICSW
• Jessica Elizabeth Wahlstrom, DPT
• Jamie Wahout
• Catherine Wain
• Debra Jean Waite, LICSW
• Nancy Waldbillig

• Physical Therapist in Saint Louis Park, MN
• Providers in Saint Louis Park, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.