Courtney Brooke Wallace, PT

Primary specialty

ContractorTaxonomy code 171W00000X

License

8974 Issued in NC

Practice address

3601 Windemere PL
Raleigh, NC 27604-5961

Phone

(919) 601-0149

NPI assigned

Apr 6, 2009

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Soarr-Steps on a Road to Recovery

  • Physical Therapist
  • Raleigh, NC
  • NPI 1396335436
  NPD Authorized official

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1285877217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9802 CARVEL CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276135754",
            "telephone_number": "984-200-2415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 WINDEMERE PL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276045961",
            "telephone_number": "919-601-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COURTNEY",
        "middle_name": "BROOKE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-06",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NC",
            "license": "8974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amaya O. Wallace, LCSW-A, LCAS
• Ashley Wallace
• Ashley Ayscue Wallace
• Barry Ray Wallace Jr.
• Beverly Rose Wallace
• Cynthia Moreno Wallace, NP
• Jocelyn Jones Wallace, LCAS-A, LPC-A
• Julie Anne Wallace, LCMHCA
• Kaitlyn D Wallace, PT
• Kathryn Paige Wallace, CCC-SLP

• Contractor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Contractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.