Douglas Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA00655300 Issued in NJ

Practice address

36 Hudson PL
Weehawken, NJ 07086-7013

Phone

(201) 522-6474

NPI assigned

Apr 14, 2021

Sex

Male

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

Enrolled in NJ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Saddle River, NJ
  • NPI 1689022295
  Medicare reassignment NPD
• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Independence, MO
  • NPI 1871072462
  NPD

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1356921118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 HUDSON PL",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070867013",
            "telephone_number": "201-522-6474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 HUDSON PL",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070867013",
            "telephone_number": "201-522-6474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00655300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tressher LLC.
• Melani Sofia Trujillo Cortes
• Junique Umejei, NP
• Valera Medical Group PC
• Maria Elena M Velez, RPH
• Joseph Walz, LMHC
• Weehawken School District
• Kimberleigh Weiss-Lewit, MA, IBCLC
• Linda Dee Whitehead, SE
• Kalyn Mashae Wickline, M.S.O.T.

• Physical Therapist in Weehawken, NJ
• Providers in Weehawken, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.