Shawn G Wallace, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1769 Issued in OK

Practice address

1805 Commons Cir Ste 100B
Yukon, OK 73099-9519

Phone

(405) 467-4086

Fax

(405) 467-4387

NPI assigned

Feb 5, 2006

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 OK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Synergy Manual Therapy Solutions LLCGroup PAC ID 4385168798, 2 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Synergy Manual Therapy Solutions LLC

  • Physical Therapist
  • Yukon, OK
  • NPI 1467289868
  Medicare reassignment Care Compare group NPD Authorized official
• Cutting Edge Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Moore, OK
  • NPI 1508272006

  Physical Therapist

  Medicare reassignment NPD Authorized official
• Cutting Edge Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Yukon, OK
  • NPI 1205352028

  Physical Therapist

  NPD Authorized official

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

{
    "created_epoch": "1139097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1457323396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 COMMONS CIR STE 100B",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730999519",
            "telephone_number": "405-467-4086",
            "fax_number": "405-467-4387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 COMMONS CIR STE 100B",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730999519",
            "telephone_number": "405-467-4086",
            "fax_number": "405-467-4387"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13390 NE 23rd St",
            "address_purpose": "LOCATION",
            "city": "Choctaw",
            "state": "OK",
            "postal_code": "730208622",
            "country_code": "US",
            "telephone_number": "405-769-5555",
            "fax_number": "405-769-5558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHAWN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-05",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "PT1769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Jo Walia, M.D.
• Jeremy Bruce Walker, PHARMD
• Suzan Walker
• William Leander Walker, ATC, LAT
• James Mark Wallen, D.PH.
• Anna Lenore Wallis, PHARM.D
• Joseph E Walsh
• Leah Walters
• Madison Paige Walterscheid, MS CCC-SLP

• Physical Therapist in Yukon, OK
• Providers in Yukon, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.