Mark Alan Wanner, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT43131 Issued in FL

Practice address

360 Palm Coast Pkwy NE
Palm Coast, FL 32137-3805

Phone

(386) 446-4101

Fax

(386) 447-2161

NPI assigned

Aug 11, 2025

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 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Rehab and Sports MedicineGroup PAC ID 5294977666, 7 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.

• Coastal Rehab and Sports Medicine

  • Physical Therapy Clinic/Center
  • Palm Coast, FL
  • NPI 1982946810

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1992680532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 PALM COAST PKWY NE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373805",
            "telephone_number": "386-446-4101",
            "fax_number": "386-447-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 PALM COAST PKWY NE",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373805",
            "telephone_number": "386-446-4101",
            "fax_number": "386-447-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNER",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT43131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PT43131",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dillan Walls
• John Alan Walsh, MD
• Mary Jane Walter, D.P.M.
• Wamu LLC
• Wamu LLC
• Hailey Ward
• Jeffrey Ward, D.O.
• Toni Marie Ward
• Paul Louis Wasserman, DO
• Marta Waszkiewicz, PTA

• Physical Therapist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.