James Victor Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

029663-1 Issued in NY

Practice address

2050 Tilden Ave
Box 1000
New Hartford, NY 13413-3613

Phone

(315) 797-3114

Fax

(315) 624-0474

NPI assigned

May 18, 2009

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Charles T Sitrin Health Care Center, Inc

  • Physical Therapist
  • New Hartford, NY
  • NPI 1215150230
  NPD
• Charles T. Sitrin Health Care Center, Inc

  • Skilled Nursing Facility
  • New Hartford, NY
  • NPI 1770589251
  NPD

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1407081649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 TILDEN AVE",
            "address_2": "PO BOX 1000",
            "city": "NEW HARTFORD",
            "state": "NY",
            "postal_code": "134133613",
            "telephone_number": "315-797-3114",
            "fax_number": "315-624-0474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 TILDEN AVE",
            "address_2": "BOX 1000",
            "city": "NEW HARTFORD",
            "state": "NY",
            "postal_code": "134133613",
            "telephone_number": "315-797-3114",
            "fax_number": "315-624-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAMES",
        "middle_name": "VICTOR",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-18",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "029663-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01815443",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00313539",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #09799)
• Walgreen Co (Rite Aid)
• Walgreen Eastern Co Inc
• Walgreens
• Michael Kevin Walsh, DO
• Mark Warfel, DO
• Jacqueline D Warmuth, OTR
• Karen Warner, NP
• Sarah A. Waskiewicz

• Physical Therapist in New Hartford, NY
• Providers in New Hartford, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.