Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum
Ethan James Wagner, DPT
Physical Therapist in Benton, AR · enumerated 2024.
Data current as of Jul 13, 2026 · sourced from CMS NPPES
National Provider Identifier
1104640879
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Registry record
Entity type Individual (Type 1)
Name Ethan James Wagner
Credential DPT
Sex Male
Practice address 20320 I 30 # 190, Benton, AR, 72019
Phone (501) 500-8188
Enumeration date Nov 11, 2024
Last updated in NPPES Nov 11, 2024
Taxonomy & licenses
225100000X Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers · License PT5585 (AR) Primary
DPT · Doctor of Physical Therapy: A physical therapist holding the clinical doctorate now standard for the profession.
About the DPT credential
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.
Frequently asked questions
Where does Ethan Wagner practice?
The practice location on file with NPPES is in Benton, AR. Providers can have multiple locations; NPPES lists the primary practice address.
What is the NPI number for Ethan Wagner?
The National Provider Identifier (NPI) for Ethan Wagner is 1104640879, a Type 1 (individual) record in the CMS NPPES registry.
Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2024-11-11.