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

Jack A Wagstrom

Individual provider Physical Therapy Assistant · NPI 1104188309

Jack A Wagstrom is a Physical Therapy Assistant in North Canton, Ohio. Licensed in Ohio. Registered with an NPI since 2012.

Licensed in
OH
In the registry since
2012

Practice location Address checks out

339 E Maple St
North Canton, OH 44720-2593
Phone: (330) 498-8200
Show map & directions

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

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence PTA. 1596 (OH)

Record details

NPI number1104188309
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 13, 2012
Last updated in NPPESJune 13, 2012
Mailing address339 E Maple St, North Canton, OH 44720-2593

Other providers in North Canton