Kimberly Thomas Wagner, PT
NPI 1518003995ActiveIndividual· Physical Therapist· Port St Joe, FL
Physical Therapist (PT) with Pro Vita Physical Therapy LLC, practicing in Port St Joe, Florida. Enrolled in Medicare as practitioner - physical therapist in private practice.
Overview
| NPI | 1518003995 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT |
| Sole proprietor | No |
| NPI issued | Jan 30, 2007 |
| Last updated in NPPES | Jan 25, 2012 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | PT17258 | FL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (FL) |
|---|
Education and affiliations
| Graduation year | 1998 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Pro Vita Physical Therapy LLCNavarre, FL · 6 clinicians
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