Andrew Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

607077550707755 Issued in WA

Practice address

730 N Hamilton St
Spokane, WA 99202-2045

Phone

(509) 458-7686

NPI assigned

Nov 17, 2016

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 WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

U District Physical Therapy and Institute of Sports PerformanceGroup PAC ID 1153312343, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• U District Physical Therapy and Institute of Sports Performance

  • Physical Therapist
  • Spokane, WA
  • NPI 1992845630
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1326580697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 N HAMILTON ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022045",
            "telephone_number": "509-458-7686",
            "fax_number": "509-808-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N HAMILTON ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022045",
            "telephone_number": "509-458-7686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-17",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "006917",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "607077550707755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendall Jennae Wall
• Leslie Ann Wall, RD
• Travis Wall
• Rea D Wallace-Vinall, LSWAIC
• Aimee Jennifer Wallace, MSPT
• Esther Wallace
• Jeffrey Eugene Wallace, LICSW, MSW, CDP, MHP
• Karlen Marie Wallace, PT, DPT
• Mackinze C Wallace, CBT
• Matthew K Wallace, M.D.

• Physical Therapist in Spokane, WA
• Providers in Spokane, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; 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.