Active NPI
Christian Wallace
- Physical Therapist
- Greenville, NC
National Provider Identifier
1023978665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P24246
- Practice address
- 2100 Stantonsburg Rd
Greenville, NC 27834-2818 - Phone
- (252) 847-4100
- NPI assigned
- Nov 17, 2025
- 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 | P24246 | NC | Primary |
Addresses
Primary practice location
2100 Stantonsburg Rd
Greenville, NC 27834-2818
Mailing address
2105 Conroy Way
Willow Spring, NC 27592-8780
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 |
|---|---|---|---|
| P24246 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763337600000",
"number": "1023978665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2105 CONROY WAY",
"city": "WILLOW SPRING",
"state": "NC",
"postal_code": "275928780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 STANTONSBURG RD",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278342818",
"telephone_number": "252-847-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "CHRISTIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-11-17",
"last_updated": "2025-11-17",
"certification_date": "2025-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P24246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.