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

Jacklyn Marie Wagner, PT, DPT, ATC

Individual provider Physical Therapist · NPI 1659745073

Jacklyn Marie Wagner, PT, DPT, ATC is a Physical Therapist in Private Practice in South Portland, Maine. Qualified in 2015, 11 years ago. Practices with Intermed PA, a 185-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Maine.

Years since qualifying
11
Licensed in
ME
In the registry since
2015
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

50 Foden Rd Ste C
South Portland, ME 04106
Phone: (207) 780-8860
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 259 Main St, Yarmouth, ME 04096-4703 — (207) 780-8860

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT5423 (ME)

Record details

NPI number1659745073
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT , DPT , ATC
Sole proprietorNo
NPI enumeratedNovember 23, 2015
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Intermed Pa — 185 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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