Robert Bowman Wallace, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P19188 Issued in NC

Practice address

5935 Carnegie Blvd Ste 104
Charlotte, NC 28209-4672

Phone

(043) 232-5007

Fax

(704) 323-3993

NPI assigned

Oct 8, 2019

Last updated

Jan 31, 2025By the provider in NPPES

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 NC, SC2 enrollments

Enrollment records 2

Merit-based Incentive Payment System (MIPS)

Final score

94 of 100Reported as apm

Quality

81.63

Promoting interoperability

100

Improvement activities

40

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1629568647

  Physical Therapist

  Medicare reassignment NPD
• Orthocarolina

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1497704217

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Lake Wylie, SC
  • NPI 1518105279

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1528683935
  NPD
• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Rock Hill, SC
  • NPI 1902443880
  NPD
• Orthocarolina

  • Orthopaedic Surgery Physician
  • Indian Land, SC
  • NPI 1619641453

  Physical Therapist

  NPD
• Foundation Health Systems LLC

  dba Novant Health Rehabilitation Center

  • Physical Therapy Clinic/Center
  • Winston Salem, NC
  • NPI 1205894029

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1255972568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601791",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601791",
            "telephone_number": "704-323-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5935 CARNEGIE BLVD STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282094672",
            "telephone_number": "043-232-5007",
            "fax_number": "704-323-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "BOWMAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-08",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P19188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lacey L Wallace
• Lester B. Wallace Jr., MD
• Monica M. Wallace, LCSW
• Noah Wallace
• Portia Dionne Wallace
• Robert T Wallace, C.PED.
• Rubye Burks Wallace, RN
• Shana Dale Wallace, MD
• Sidiqat Wallace
• Terry W Wallace, M.D.

• Physical Therapist in Charlotte, NC
• Providers in Charlotte, 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 Jan 31, 2025; 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.