Elizabeth Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10476 Issued in NC

Practice address

1004 Oakgrove Dr
Knightdale, NC 27545-9295

Phone

(919) 880-0718

NPI assigned

Oct 1, 2014

Last updated

Oct 1, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Therapy LLCGroup PAC ID 1153317300, 48 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.

• Integrated Therapy LLC

  • Physical Therapist
  • Atlanta, GA
  • NPI 1326247248

  NC

  Medicare reassignment Care Compare group NPD
• Life Clinic of NC PC

  dba LifeClinic of Franklin

  • Chiropractor
  • Raleigh, NC
  • NPI 1437650843

  Physical Therapist

  NPD
• Life Clinic of Ga PC

  • Chiropractor
  • Woodstock, GA
  • NPI 1922752807

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412121600000",
    "number": "1083017206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 OAKGROVE DR",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 OAKGROVE DR",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459295",
            "telephone_number": "919-880-0718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELIZABETH",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "10476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wake Renewal Counseling, PLLC
• Wake Specialty Physicians LLC (WakeMed Primary Care Knightdale)
• Wake Spine and Disc Inc
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1816)
• Walgreen Co (Walgreens #09555)
• Lindsay Jordan James Walters, CPNP
• Cherie Nicole Watlington, MSW, LCSW
• Linwood Worth Watson, MD
• Teneshia Webb, LCSWA
• Wecare American Labs, Inc

• Physical Therapist in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.