Stephen Paden Wallace, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT012936 Issued in GA

Practice address

925 Garrett St SE Ste J
Atlanta, GA 30316-6833

Phone

(404) 624-5407

Fax

(404) 624-5409

NPI assigned

May 24, 2017

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, TN2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Results-Ast JV LLCGroup PAC ID 4486066396, 390 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Results-Ast JV, LLC

  • Physical Therapist
  • Franklin, TN
  • NPI 1780291948
  Medicare reassignment Care Compare group NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Duluth, GA
  • NPI 1083666903
  Medicare reassignment NPD
• Independent Physical Therapy of Georgia, LLC

  dba BenchMark Physical Therapy

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Snellville, GA
  • NPI 1942592092
  NPD
• Independent Physical Therapy of Georgia, LLC

  dba Benchmark PT

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Atlanta, GA
  • NPI 1801815816
  NPD (past)
• Independent Physical Therapy of Georgia , LLC

  • Physical Therapist
  • Dalton, GA
  • NPI 1003868225
  NPD (past)
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapy Clinic/Center
  • Dunwoody, GA
  • NPI 1376956003
  NPD (past)

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1053849802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-362-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 GARRETT ST SE STE J",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303166833",
            "telephone_number": "404-624-5407",
            "fax_number": "404-624-5409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5500 Chamblee Dunwoody Rd Ste 5B",
            "address_purpose": "LOCATION",
            "city": "Dunwoody",
            "state": "GA",
            "postal_code": "303384162",
            "country_code": "US",
            "telephone_number": "770-396-3003",
            "fax_number": "770-396-3868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHEN",
        "middle_name": "PADEN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-24",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT012936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Robert Wallace, D.D.S
• Jennifer Wallace, MS, CCC-SLP
• Kennedy Fayrene Wallace
• Minnie Wallace
• Satin Wallace
• Timothy Brian Wallace II, M.D.
• Tracey Wallace
• Tracey C Wallace, M.D.
• Tracy Clark Wallace, PT
• Jenny Anne Walldorf, M.D.

• Physical Therapist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.