MR. BRYAN WAGNER (NPI# 1871016295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871016295 |
| Entity Type | Individual |
| Full Name | MR. BRYAN WAGNER |
| Credential | ATC, LAT |
| Practice Address |
1045 Riverside Ave 190 Jacksonville FL 32201 |
| Mailing Address |
1045 Riverside Ave 190 Jacksonville FL 32204 |
| Practice Telephone | 9046474284 |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2017-07-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
AL4839 | FL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629621545 | Bryan L Wagner | Dentist | 8300 Hough Ave, Cleveland, OH 44103-4247 | 2019-07-19 |
| Street Address |
1045 RIVERSIDE AVE 190 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164596649 | Heartland Rehabilitation Services of Florida LLC | Clinic/Center | 1045 Riverside Ave, Suite 190, Jacksonville, FL 32204-4127 | 2006-11-17 |
| 1447769369 | Kaylee Munch | Occupational Therapist | 1045 Riverside Ave, Jacksonville, FL 32204-4127 | 2017-09-22 |
| 1457802688 | Kathryn Kane | Physical Therapy Assistant | 1045 Riverside Ave, Jacksonville, FL 32204-4127 | 2016-10-24 |
| 1174077218 | Kelsey Grimaldi | Specialist/Technologist | 1045 Riverside Ave, #190, Jacksonville, FL 32204-4127 | 2016-08-05 |
| 1558734079 | Cameron Juneau | Physical Therapy Assistant | 1045 Riverside Ave, Suite190, Jacksonville, FL 32204-4127 | 2015-11-05 |
| 1669805693 | Stephanie Sulkala | Specialist | 1045 Riverside Ave, Suite 190, Jacksonville, FL 32204-4127 | 2013-08-13 |
| 1235413063 | Jamie Lee Erickson | Specialist/Technologist | 1045 Riverside Ave, #190, Jacksonville, FL 32204-4127 | 2011-09-28 |
| 1104068915 | Florida O&p Services Inc | Prosthetic/Orthotic Supplier | 1045 Riverside Ave, Suite 100, Jacksonville, FL 32204-4127 | 2009-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740224 | North Florida Collaborative Therapy | Psychologist | 9652 Morgan Creek Ct, Jacksonville, FL 32222-5808 | 2020-11-05 |
| 1477154680 | C.n.e Health Care LLC | In Home Supportive Care | 10859 Jessica Ash Dr, Jacksonville, FL 32218-6537 | 2020-11-04 |
| 1972104198 | Kristen Dragotta | Physical Therapist | 8876 A C Skinner Pkwy Unit 8215, Jacksonville, FL 32256-0909 | 2020-11-04 |
| 1376144774 | Jennifer Mcmanus | Psychologist | 4143 San Juan Ave, Jacksonville, FL 32210-3333 | 2020-11-03 |
| 1134720519 | Ashley Harms | Counselor | 4070 Herschel St Ste 1, Jacksonville, FL 32210-2239 | 2020-11-03 |
| 1063013647 | Tia Patterson | Nurse's Aide | 9415 Devonshire Blvd, Jacksonville, FL 32208-7002 | 2020-11-02 |
| 1669073128 | Kandra Williams | Pharmacist | 10148 Kings Crossing Dr, Jacksonville, FL 32219-7621 | 2020-11-02 |
| 1104427632 | Sunzup Counseling and Wellness | Community/Behavioral Health | 3355 Claire Ln Apt 1116, Jacksonville, FL 32223-6662 | 2020-11-02 |
| 1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
| 1902406598 | Heidi Ellen Page | Registered Nurse | 3960 Marsh Bluff Dr, Jacksonville, FL 32226-4783 | 2020-11-01 |
| Find all providers in JACKSONVILLE | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003423880 | Amber Simerly Magliocca | Specialist/Technologist | 410 New Bridge St Ste 7b, Jacksonville, NC 28540-4759 | 2020-09-25 |
| 1730717091 | Bryan M Langan | Specialist/Technologist | 8 Sunnydale Ave, Jacksonville, IL 62650-2656 | 2020-03-31 |
| 1184257065 | Tory Ann Cooper | Specialist/Technologist | 8136 Pine Springs Ln, Jacksonville, FL 32244-7445 | 2020-02-19 |
| 1356974372 | Noelle Parker | Specialist/Technologist | 1 Unf Drivve, Jacksonville, FL 32224 | 2020-02-18 |
| 1194360008 | Shaylee Jade Fouts | Specialist/Technologist | 1210 Corinth Rd, Jacksonville, TX 75766-3208 | 2019-11-14 |
| 1700436144 | Griffin Loflin | Specialist/Technologist | 775 Park Ave Nw, Attn. Sports Medicine, Jacksonville, AL 36265 | 2019-09-17 |
| 1124685102 | Charcy Rene Stiller | Specialist/Technologist | 1 Unf Dr., Jacksonville, FL 32224 | 2019-05-24 |
| 1639733975 | Logen Izzak Hirn | Specialist/Technologist | 141 Lakewood Dr, Jacksonville, NC 28546-4633 | 2019-04-23 |
| 1568924348 | Thomas Bradley Vickers | Specialist/Technologist | 11911 Cornelius St, Jacksonville, FL 32246-4004 | 2019-04-02 |
| 1063971729 | Leonardo Sierra | Specialist/Technologist | 11057 Stutz Ct, Jacksonville, FL 32246-1401 | 2019-03-13 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32201 |
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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.