David Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

039257 Issued in NY

Practice address

552 6TH Ave
New York, NY 10011-2010

Phone

(212) 741-9288

Fax

(212) 741-6826

NPI assigned

Aug 21, 2015

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 NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jag-One Physical Therapy LLCGroup PAC ID 2769584325, 334 clinicians

Kinetic Home Therapy Services LLCGroup PAC ID 5496131872, 11 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 and National Provider Directory roles.

• Jag-One Physical Therapy, LLC

  • Physical Therapist
  • West Orange, NJ
  • NPI 1518017144
  Medicare reassignment Care Compare group NPD
• Kinetic Home Therapy Services LLC

  • Home Health Agency
  • Wayne, NJ
  • NPI 1528788502
  Medicare reassignment Care Compare group
• Balanced Body Rehabilitation LLC

  • Physical Therapist
  • Tenafly, NJ
  • NPI 1740690627
  Medicare reassignment NPD
• Movement Solutions Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Teaneck, NJ
  • NPI 1104789395
  NPD Authorized official
• Outreach Physical and Occupational Therapy & Speech Rehabilitation, PLLC

  • Physical Therapist
  • Great Neck, NY
  • NPI 1841526399

  NJ

  Medicare reassignment

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440115200000",
    "number": "1154798486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 UTOPIA PKWY",
            "city": "WHITESTONE",
            "state": "NY",
            "postal_code": "113574142",
            "telephone_number": "718-819-6800",
            "fax_number": "347-841-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "552 6TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100112010",
            "telephone_number": "212-741-9288",
            "fax_number": "212-741-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "039257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Rose Wallace, MD
• Barbara Cornelia Wallace
• Brynn Wallace, LCSW
• Chantay Wallace
• Charles Jerome Wallace, CASAC-T
• Kathleen Wallace
• Kisha Wallace
• Kyana Wallace, PA-C
• Laney Elizabeth Wallace, MPS, LCAT, ATR-BC
• Lauren Wallace

• Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; 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.