Judy Lynn Wallis, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

Marywood Health Center
111 Lakeside Drive NE
Grand Rapids, MI 49503

Phone

(616) 453-7715

NPI assigned

May 17, 2007

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1356558324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8572 MCARTHUR AVE NE",
            "city": "GREENVILLE",
            "state": "MI",
            "postal_code": "488388372",
            "telephone_number": "616-481-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MARYWOOD HEALTH CENTER",
            "address_2": "111 LAKESIDE DRIVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-453-7715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JUDY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502000688",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Wallager, CMA
• Caitlyn Waller
• Shannon Waller
• Ashleigh Renee Wallin, B.S
• Cornelia Wallis, PT
• Bradley J Wallsteadt, LMSW
• Richard Arlen Wallus
• Shea Wallus, LMSW
• Jolene Faye Walma
• Krisin M Wals, LMSW

• Physical Therapy Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; 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.