Maureen V Wallace, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1931 Issued in MT

Practice address

2430 N. 7TH
Unit 2
Bozeman, MT 59715

Phone

(406) 586-2772

Fax

(406) 586-2644

NPI assigned

Jul 15, 2006

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

Other identifiers 2

Other names 1

• Maureen Tamara Van Horn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Advanced Performance & Rehabilitation Services Inc

  • Physical Therapy Clinic/Center
  • Bozeman, MT
  • NPI 1326064916

  Physical Therapist

  NPD (past)
• Alta Physical Therapy & Fitness Inc

  • Physical Therapy Clinic/Center
  • Bozeman, MT
  • NPI 1801934211

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258934400000",
    "number": "1396761995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4739 MEADOW LANE",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-586-2772",
            "fax_number": "406-586-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 N. 7TH",
            "address_2": "UNIT 2",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-586-2772",
            "fax_number": "406-586-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MAUREEN",
        "middle_name": "V",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-15",
        "last_updated": "2009-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "1931PT",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "1931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MT",
            "identifier": "000061621",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3402057",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAUREEN",
            "last_name": "VAN HORN",
            "middle_name": "TAMARA",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Catherine F Walgren, PAC
• Rachel Walker
• Tammy Jane Walker, OTR
• Adrianne V Wallace, MFTLC
• Joshua Wallace, LMT
• Richard M. Wallace, M.D.
• Steven Mark Wallace, L.M.T
• Kimberly Glendoria Wallen, CRNA
• John L Waller, MD
• Christopher Ryan Wallis, D.D.S.

• All providers in Bozeman, MT
• Physical Therapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.