Active NPI
Richard Lance Wallace, PT
- Physical Therapist
- Chesterfield, SC
National Provider Identifier
1023242112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2559
- Practice address
- 1034 Buchanan Bridge Rd
Chesterfield, SC 29709-6154 - Phone
- (843) 623-9232
- Fax
- (843) 320-1003
- NPI assigned
- May 5, 2009
- Last updated
- May 5, 2009
- Sex
- Male
- 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 | 2559 | SC | Primary |
Addresses
Primary practice location
1034 Buchanan Bridge Rd
Chesterfield, SC 29709-6154
Mailing address
1034 Buchanan Bridge Rd
Chesterfield, SC 29709-6154
Phone (843) 623-9232
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241481600000",
"number": "1023242112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1034 BUCHANAN BRIDGE RD",
"city": "CHESTERFIELD",
"state": "SC",
"postal_code": "297096154",
"telephone_number": "843-623-9232",
"fax_number": "843-320-1003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1034 BUCHANAN BRIDGE RD",
"city": "CHESTERFIELD",
"state": "SC",
"postal_code": "297096154",
"telephone_number": "843-623-9232",
"fax_number": "843-320-1003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "RICHARD",
"middle_name": "LANCE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-05",
"last_updated": "2009-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "2559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesterfield, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.