Bethann Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305005759 Issued in VA

Legal business name

BETHANN WALLACE

Doing business as

Staunton Physical Therapy

Practice address

1416 Churchville Ave
Suite a
Staunton, VA 24401

Phone

(540) 213-0345

Fax

(540) 886-2609

NPI assigned

Dec 19, 2006

Last updated

Jul 14, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Bethann Wallace, PT PHYSICAL THERAPISNPI 1942464219

Title

Owner

Phone

(540) 213-0345

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Staunton Physical Therapy Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bethann Wallace, PT

  • Physical Therapist
  • Staunton, VA
  • NPI 1942464219
  NPD (past) Authorized official
• Edwin Rush Wallace III, MPT

  • Physical Therapist
  • Plainsboro, NJ
  • NPI 1790968154
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1396809125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 CHURCHVILLE AVE",
            "address_2": "SUITE A",
            "city": "STAUNTON",
            "state": "VA",
            "postal_code": "24401",
            "telephone_number": "540-213-0345",
            "fax_number": "540-886-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 CHURCHVILLE AVE",
            "address_2": "SUITE A",
            "city": "STAUNTON",
            "state": "VA",
            "postal_code": "24401",
            "telephone_number": "540-213-0345",
            "fax_number": "540-886-2609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANN WALLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BETHANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-213-0345",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT PHYSICAL THERAPIS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305005759",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "235005465",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "194028",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Staunton Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Benchmark Physical Therapy of VA, LLC
• Luanne Faye Bender Long, LPC, LMFT
• Marna Bentley, LPC
• Caroline Berry, PA-C
• Daniel James Bessette
• Bethesda Physical Therapy and Wellness, Inc.
• Michelle Smith Beverly
• BH Brightview Baldwin Park Opco, LLC (Brightview Baldwin Park)
• BHG Lix, LLC (BHG Medical Services Staunton)
• Ronny Perry Bigham, PA-C

• Physical Therapist in Staunton, VA
• Providers in Staunton, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.