JAMES BLAKE WAGNER (NPI# 1306804448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306804448 |
Entity Type | Individual |
Full Name | JAMES BLAKE WAGNER |
Credential | P.T. |
Practice Address |
1525 Country Club Rd Sherwood AR 72120-5076 |
Practice Telephone | 5019783135 |
Practice Fax Number | 5019783138 |
Mailing Telephone | 5019783135 |
Mailing Fax Number | 5019783138 |
Enumeration Date | 2006-05-01 |
Last Update Date | 2014-03-11 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 2251S0007X |
Physical Therapist Specialization: Sports |
PT2565 | AR | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
PT2565 | AR | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AR | AR BLUE CROSS BLUE SHIELD | 5W797C153 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568965234 | James Wagner | Physical Therapy Assistant | 316 Madison St, Niles, MI 49120-3128 | 2018-03-08 |
1245740687 | James Wagner | Marriage & Family Therapist | 2324 University Ave W Ste 100, Saint Paul, MN 55114-8759 | 2017-10-11 |
1558754168 | James Edwin Wagner | Licensed Practical Nurse | 377 Peyton Road S W, Atlanta, GA 30311 | 2015-03-07 |
1598969545 | James William Wagner | Chiropractor | 9574 Murray Dr, La Mesa, CA 91942 | 2007-06-13 |
1326188293 | James George Wagner | Obstetrics & Gynecology | 8000 Ave. J.t. Pinero, Plaza Cayey, Of. 204, Cayey, PR 00736 | 2007-02-08 |
1851469480 | James P Wagner | Family Medicine | 708 Viand Street, Point Pleasant, WV 25550 | 2006-12-01 |
1255412615 | James Allen Wagner | Rehabilitation Counselor | 11301 Wilshire Bl., Los Angeles, CA 90073 | 2006-10-18 |
1073536934 | James D Wagner | Internal Medicine | 890 Beaver Grade Rd Ste 3, Moon Township, PA 15108-2653 | 2006-07-25 |
1295783256 | James M Wagner | Dentist | 2620 Regatta Dr, 110, Las Vegas, NV 89128-6891 | 2006-05-04 |
1851379044 | James M Wagner | Chiropractor | 1162 Dexter St, Milan, MI 48160-1162 | 2006-01-06 |
Street Address |
1525 COUNTRY CLUB RD |
City | SHERWOOD |
State | AR |
Zip Code | 72120-5076 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598072480 | Crystal Miller Goodman | Physical Therapist | 1525 Country Club Rd, Attn: Physical Therapy Department, Sherwood, AR 72120-5076 | 2010-09-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215409818 | Mary Kaye Hill | Physical Therapist | 6020 Warden Road, Sherwood, AR 72120 | 2018-12-20 |
1043714694 | Healthcare Express, LLP | Clinic/Center | 1554 Country Club Road, Sherwood, AR 72120 | 2018-03-20 |
1265957690 | Darryl Nathaniel Griffith | Massage Therapist | 9871 Brockington Road, Suite #1, Sherwood, AR 72120 | 2017-08-07 |
1669841011 | Sarah Katherine Stephenson | Pharmacist | 102 Brockington Rd, Sherwood, AR 72120 | 2015-09-16 |
1063803328 | The Legacy for Children and Families | Counselor | 190 Jan Drive, Suite #10, Sherwood, AR 72120 | 2015-02-09 |
1417297235 | Andrew Hunter Beavers | Counselor | 37 Walton Rd., Sherwood, AR 72120 | 2013-02-15 |
1003156886 | Infinity Hearing Center Inc. | Hearing Aid Equipment | 3115 E Kiehl Ave, Suite B, Sherwood, AR 72120 | 2013-02-15 |
1548543234 | Lorrie Ann George | Early Intervention Provider Agency | 207 Fred Rains Drive, Sherwood, AR 72120 | 2011-09-20 |
1033411897 | Tessa Monique Davis | Occupational Therapist | 21 Gunstock Lane, North Little Rock, AR 72120 | 2010-11-30 |
1720307903 | Yousef Arfan Fahoum | Psychologist | 2215 Wildwood Ave Ste 200, Sherwood, AR 72120 | 2010-05-27 |
Find all providers in zip 72120 |
Taxonomy Code | 2251X0800X |
Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Classification | Physical Therapist |
Specialization | Orthopedic |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427445386 | Brandon Rotap | Physical Therapist | 16770 Sw Edy Rd Ste 310, Sherwood, OR 97140 | 2015-04-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861007841 | Branden Shane Blume | Physical Therapist | 5300 S Southern Hills Ct # 200, Rogers, AR 72758-3500 | 2020-09-15 |
1154848133 | Zach Brown | Physical Therapist | 4540 Jfk Blvd, North Little Rock, AR 72116-7309 | 2017-08-29 |
1275933772 | Haley Mourot | Physical Therapist | 100 Walmart Dr Ste 5, Morrilton, AR 72110-4525 | 2014-09-03 |
1093153173 | Christian Charles Robertozzi | Physical Therapist | 907 Se Village Loop Ste 5, Bentonville, AR 72712-2229 | 2013-06-11 |
1023320132 | Rachael Lee Cummins Owens | Physical Therapist | 1065 Clayton St Ste 9, Conway, AR 72032-4335 | 2010-07-06 |
1275605727 | Brian Paul Doorley | Physical Therapist | 16140 N Arrowhead Fountain Center Drive, Suite 105, Peoria, AR 85382 | 2006-11-13 |
1467554964 | Bryan Nathaniel Grubbs | Physical Therapist | 1200 Old Warren Road, Monticello, AR 71655-3954 | 2006-09-04 |
1740243559 | Anna Christine Turner-massanelli | Physical Therapist | 2113 Watts Road, Jordan Physical Therapy, Benton, AR 71901 | 2006-04-11 |
1124017058 | Rowdy Kelly | Physical Therapist | 200 N College St, Mountain Home, AR 72653-3654 | 2005-10-13 |
1750865044 | Ruth Ross | Physical Therapist | 1125 N College Ave, Fayetteville, AR 72703-1908 | 2018-09-21 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.