Amy Wallenburg, P.T., M.P.T.

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

5501012840 Issued in MI

Practice address

26 N State St
Suite 400
Zeeland, MI 49464-1281

Phone

(616) 772-5643

Fax

(616) 772-5819

NPI assigned

Aug 22, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1282435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283644800000",
    "number": "1063728509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 N STATE ST",
            "address_2": "SUITE 400",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494641281",
            "telephone_number": "616-772-5643",
            "fax_number": "616-772-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 N STATE ST",
            "address_2": "SUITE 400",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494641281",
            "telephone_number": "616-772-5643",
            "fax_number": "616-772-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENBURG",
        "first_name": "AMY",
        "credential": "P.T., M.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-22",
        "last_updated": "2010-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MI",
            "license": "5501012840",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501012840",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annica E Waalkes, MD
• Philip Waalkes, DO
• Rebecca Joy Wagner
• Abagale H Wallace
• Kelsey Wallace, OTR/L
• Walter C Rottschafer DPM PC
• Allison Walter
• Melissa Nicole Wangler, NP
• Frank Edward Warren, DC
• Robin Webb, MD

• Pediatric Physical Therapist in Zeeland, MI
• Providers in Zeeland, MI by specialty
• Pediatric Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2010; 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.