Stephen Paden Wallace, PT, DPT
Individual provider Active NPI Physical Therapist · Atlanta, GA
NPI 1053849802 · NPPES record last updated Sep 25, 2019
Key facts
- NPI
- 1053849802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT012936 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- 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 LLC
Practice addresses (Care Compare)
3556 Tom Austin Hwy
Suite 2
Springfield, TN 37172-3960
Phone (615) 492-4595
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA, TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170801000475 | GA | Practitioner - Physical Therapist in Private Practice | 8921379553 | Reassigns benefits to 2 organizations |
| I20230808004151 | TN | Practitioner - Physical Therapist in Private Practice | 8921379553 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT012936 | GA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Independent Physical Therapy of Georgia, LLC | Physical Therapist | Current |
Accepting new patients |
| Benchmark Physical Therapy, Inc | Current |
Accepting new patients | |
| Independent Physical Therapy of Georgia, LLC | Physical Therapist | Current |
Accepting new patients |
| Benchmark Physical Therapy, Inc | Current |
Accepting new patients | |
| Results-Ast JV, LLC | Physical Therapist | Current |
Accepting new patients |
| Independent Physical Therapy of Georgia, LLC | Past | Accepting new patients | |
| Independent Physical Therapy of Georgia , LLC | Physical Therapist | Past |
Accepting new patients |
| Benchmark Physical Therapy, Inc | Past |
Accepting new patients |
Locations
1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568
1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001
5500 Chamblee Dunwoody Rd
Ste 5B
Dunwoody, GA 30338
Phone (678) 981-6290
5500 Chamblee Dunwoody Rd
Ste 5E
Dunwoody, GA 30338
Phone (678) 256-3920
7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660
11490 Alpharetta Hwy
Ste 200
Roswell, GA 30076
Phone (770) 740-8592
1615 State Highway 17
Ste 9
Young Harris, GA 30582
Phone (706) 896-2771
6397 Lee Hwy
Ste 300
Chattanooga, TN 37421
Phone (423) 238-8923
8823 Production Ln
Ooltewah, TN 37363
Phone (423) 238-8923
3556 Tom Austin Hwy
Ste 2
Springfield, TN 37172
Phone (615) 492-4595
2030 Cowan Hwy
Ste 1
Winchester, TN 37398
Phone (931) 968-1080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT012936 | GA | Yes |
Addresses
Primary practice location
925 Garrett St SE Ste J
Atlanta, GA 30316-6833
Mailing address
8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217
Other practice location 1
5500 Chamblee Dunwoody Rd Ste 5B
Dunwoody, GA 30338-4162
Phone (770) 396-3003
Other providers in Atlanta, GA
- Jeffrey Robert Wallace
- Jennifer Wallace
- Kennedy Fayrene Wallace
- Minnie Wallace
- Satin Wallace
- Timothy Brian Wallace II
- Tracey Wallace
- Tracey C Wallace
- Tracy Clark Wallace
- Jenny Anne Walldorf
All providers in Atlanta, GA · Physical Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.