NPIMap

Individual provider Active NPI

John E Wallace, DPT

  • Physical Therapist
  • Cincinnati, OH
National Provider Identifier
1023508868
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-017396 Issued in OH
Practice address
1060 Nimitzview Dr Ste 205
Cincinnati, OH 45230-4351
Phone
(513) 474-8600
Fax
(513) 474-0623
NPI assigned
May 17, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-017396 OH Primary

Addresses

Primary practice location

1060 Nimitzview Dr Ste 205
Cincinnati, OH 45230-4351

Mailing address

7567 Central Parke Blvd Ste a
Mason, OH 45040-6855
Phone (513) 701-6100

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

LicenseStateTypeSpecialty
PT-017396OHMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Physical Therapy Services, Inc Physical Therapist Past Accepting new patients
Oxford Physical Therapy and Rehabilitation Physical Therapist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1023508868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7567 CENTRAL PARKE BLVD STE A",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450406855",
            "telephone_number": "513-701-6100",
            "fax_number": "513-701-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 NIMITZVIEW DR STE 205",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452304351",
            "telephone_number": "513-474-8600",
            "fax_number": "513-474-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT-017396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.