Serena A Wallace, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61456638 Issued in WA

Practice address

275 W Hospitality LN Ste 100
San Bernardino, CA 92408-3238

Phone

(909) 567-2221

Fax

(909) 763-3216

NPI assigned

Aug 3, 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)

Enrolled

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.

• Transit Physical Therapy PC

  • Physical Therapy Clinic/Center
  • San Bernardino, CA
  • NPI 1417485889

  Physical Therapist

  NPD
• Aeroflow Connect LLC

  • Lactation Consultant (Non-RN)
  • Asheville, NC
  • NPI 1790306819
  NPD (past)

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1194407668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 W OLIVE AVE APT 3",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738810",
            "telephone_number": "206-412-8460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W HOSPITALITY LN STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083238",
            "telephone_number": "909-567-2221",
            "fax_number": "909-763-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SERENA",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-03",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61456638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Walker, PT
• Lavon Walker
• Leonie Walker, LCSW
• Patience Walker
• Daniel Montes Wallace
• Susan O'Brien Wallace, PSY. D.
• Christa Ann Wallis, LMFT
• Antonia Walls
• Mysheva Walls
• Walmart Inc.

• Physical Therapist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.