Heather Marie Wallace

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1361 E Cypress Ave Ste E
Redding, CA 96002-0283

Phone

(530) 691-9940

NPI assigned

Dec 1, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1154197929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 LITTLE ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960032231",
            "telephone_number": "530-691-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 E CYPRESS AVE STE E",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960020283",
            "telephone_number": "530-691-9940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HEATHER",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-01",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan M Walker, OTR/L
• Wayne D Walker
• Amanda Wall
• Matthew Wall, MASSAGE THERAPIST
• Norman Wall, DO
• Kathleen Wallace, PT, DPT
• Mark D Wallace, M.D.
• Nathan Wallace
• Walmart Inc.
• Walmart, Inc.

• Athletic Trainer in Redding, CA
• Providers in Redding, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.