Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blake Douglas Wagner, PT

Individual provider Physical Therapist · NPI 1811057664

Blake Douglas Wagner, PT is a Physical Therapist in Fremont, Nebraska. Licensed in Iowa and Nebraska. Registered with an NPI since 2006.

Licensed in
IA, NE
In the registry since
2006
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

410 E 22nd St Ste 2
Fremont, NE 68025-2640
Phone: (800) 974-4378
Fax: (630) 515-1536
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 1004 (NE)
Physical Therapist Taxonomy 225100000X · Licence 01883 (IA)

Record details

NPI number1811057664
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedDecember 11, 2006
Last updated in NPPESOctober 30, 2023
Certification dateOctober 30, 2023
Mailing address24014 W Renwick Rd Unit 206, Plainfield, IL 60544-8711

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