Jennifer L Wallace, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

22282 Issued in FL

Practice address

3891 50TH Ave S
Saint Petersburg, FL 33711-4811

Phone

(630) 554-4701

NPI assigned

Oct 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272844800000",
    "number": "1306035431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3891 50TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337114811",
            "telephone_number": "630-554-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3891 50TH AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337114811",
            "telephone_number": "630-554-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-15",
        "last_updated": "2010-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "22282",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.009079",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis Aaron Walker, MD
• Wall Dermatology, LLC
• Kimberly Wall, CRT
• Weston Wall, MD
• Anna Joan Wallace, COTA
• Jennifer Lea Wallace, PAC
• Jennifer M Wallace, PA-C
• Kristie Jackson Wallace, PHARMD
• Kristin Elise Wallace, LMHC
• Ora Wallace

• Physical Therapist in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; 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.