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

Jack Wagner

Individual provider Physical Therapist · NPI 1962398131

Jack Wagner is a Physical Therapist in Private Practice in Indianapolis, Indiana. Qualified in 2025, 1 year ago. Practices with Team Rehabilitation Services LLC, a 569-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
1
Licensed in
IN
In the registry since
2025
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Practice location Address checks out

8628 Purdue Rd
Indianapolis, IN 46268-1114
Phone: (317) 677-0660
Fax: (317) 667-0640
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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 05016107A (IN)

Record details

NPI number1962398131
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 16, 2025
Last updated in NPPESAugust 8, 2025
Certification dateAugust 8, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Team Rehabilitation Services Llc — 569 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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