Jack Wagstrom
NPI 1104188309 · Physical Therapy Assistant · North Canton, OH
Jack Wagstrom is a Physical Therapy Assistant provider in North Canton, OH (NPI 1104188309).
Provider details
- NPI number
- 1104188309
- Entity type
- Individual
- Primary specialty
- Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- PTA. 1596 (OH)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2012-06-13
- Last updated
- 2012-06-13
Frequently asked questions
- What is Jack Wagstrom's NPI number?
- Jack Wagstrom's National Provider Identifier (NPI) is 1104188309, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Jack Wagstrom's specialty?
- Jack Wagstrom is listed in the NPPES registry with a primary specialty of Physical Therapy Assistant (Respiratory, Developmental, Rehabilitative and Restorative Service Providers).
- Where is Jack Wagstrom located?
- Jack Wagstrom's practice location on file with NPPES is 339 E Maple St, North Canton, OH 44720-2593.
- What is Jack Wagstrom's phone number?
- The practice phone number listed in the NPPES registry for Jack Wagstrom is (330) 498-8200.
- Is Jack Wagstrom's NPI active?
- Yes — Jack Wagstrom's NPI (1104188309) is active in the NPPES registry as of the last update on 2012-06-13.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.