Blake Douglas Wagner, PT

Physical Therapist · Fremont, NE

Individual Active NPI

NPI number 1811057664

Practice location

410 E 22ND St Ste 2
Fremont, NE 68025-2640
Phone
(800) 974-4378
Fax
(630) 515-1536

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NPI record

NPI
1811057664
Entity type
Individual (Type 1)
Enumeration date
December 11, 2006
Last updated
October 30, 2023
Certified
October 30, 2023
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physical Therapist Primary 225100000X 1004 NE
Physical Therapist 225100000X 01883 IA

Mailing address

24014 W Renwick Rd Unit 206
Plainfield, IL 60544-8711
Phone
(800) 974-4378
Fax
(630) 515-1536

About Blake Wagner

Blake Douglas Wagner, PT is a healthcare provider registered in the NPI registry with the primary taxonomy Physical Therapist (code 225100000X). The practice location is 410 E 22ND St Ste 2, Fremont, NE 68025-2640. The NPI number 1811057664 was assigned on December 11, 2006 and the record was last updated on October 30, 2023.

Blake Wagner lists 2 licenses in the registry: #1004 (NE) for Physical Therapist; #01883 (IA) for Physical Therapist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Blake Douglas Wagner, PT?

The NPI number is 1811057664.

What is the phone number of Blake Wagner?

The phone number listed for the practice location is (800) 974-4378.

Where is Blake Wagner located?

410 E 22ND St Ste 2, Fremont, NE 68025-2640.

What is the taxonomy code for Blake Wagner?

The primary taxonomy code is 225100000X – Physical Therapist; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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