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

Ethan James Wagner, DPT

Individual provider Physical Therapist · NPI 1104640879

Ethan James Wagner, DPT is a Physical Therapist in Benton, Arkansas. Licensed in Arkansas. Registered with an NPI since 2024.

Licensed in
AR
In the registry since
2024
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

20320 I 30 # 190
Benton, AR 72019-8027
Phone: (501) 500-8188
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT5585 (AR)

Record details

NPI number1104640879
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedNovember 11, 2024
Last updated in NPPESNovember 11, 2024
Certification dateNovember 11, 2024
Mailing address1200 Corporate Dr Ste 400, Hoover, AL 35242-5424

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