Camron Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P23482 Issued in NC

Practice address

1129 E Marion St
Shelby, NC 28150-4843

Phone

(704) 471-0001

NPI assigned

May 23, 2024

Last updated

Aug 13, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, GA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab North Carolina LLCGroup PAC ID 8820336324, 158 clinicians

Atlanta Rehabilitation and Performance CenterGroup PAC ID 5890692917, 95 clinicians

Practice addresses (Care Compare)

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 Care Compare group NPD
• Atlanta Rehabilitation and Performance Center

  dba nMotion Physical Therapy

  • Physical Therapy Clinic/Center
  • Cleveland, GA
  • NPI 1982797494
  Medicare reassignment Care Compare group NPD
• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1528683935
  NPD
• Atlanta Rehabilitation and Performance Center

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
  • NPI 1013789205
  NPD

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

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1306685722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 CRESTVIEW DR",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281504267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 E MARION ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281504843",
            "telephone_number": "704-471-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CAMRON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P23482",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #09562)
• Walgreen Co. (Greenheck Group Pharmacy)
• Carlie Alyssa Walker, MS, CCC-SLP
• Cortney Steele Walker, OTRL
• Tiffany Renee Walker, CERTIFIED DOULA
• Jacob Tyler Wallace, PHARMD
• Matthew W Warren, PHARMD
• Mitchell Warren, MD
• Bianca S Washington, FNP-BC
• Abby Charles Waters, LCSW-A

• Physical Therapist in Shelby, NC
• Providers in Shelby, 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 Aug 13, 2024; 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.