Active NPI
Brittany Wallace, PT, DPT
- Physical Therapist
- Lake Worth, FL
National Provider Identifier
1013588714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 36212
- Practice address
- 7103 Lake Worth Rd
Lake Worth, FL 33467-2906 - Phone
- (561) 702-2025
- NPI assigned
- Jul 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 36212 | FL | Primary |
Addresses
Primary practice location
7103 Lake Worth Rd
Lake Worth, FL 33467-2906
Mailing address
9112 Cove Point Cir
Boynton Beach, FL 33472-2762
Phone (561) 702-2025
Other practice location 1
7150 Devons Rd Unit 13-14
Riviera Beach, FL 33404-5821
Phone (561) 702-2025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36212 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625443200000",
"number": "1013588714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9112 COVE POINT CIR",
"city": "BOYNTON BEACH",
"state": "FL",
"postal_code": "334722762",
"telephone_number": "561-702-2025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7103 LAKE WORTH RD",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334672906",
"telephone_number": "561-702-2025"
}
],
"practiceLocations": [
{
"address_1": "7150 Devons Rd Unit 13-14",
"address_purpose": "LOCATION",
"city": "Riviera Beach",
"state": "FL",
"postal_code": "334045821",
"country_code": "US",
"telephone_number": "561-702-2025",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "BRITTANY",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-05",
"last_updated": "2021-07-05",
"certification_date": "2021-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "36212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.