Guy Robert Wallace, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

002884 Issued in KY

Practice address

1222 Woodland Dr
Elizabethtown, KY 42701-2710

Phone

(270) 234-1569

Fax

(270) 234-0680

NPI assigned

Jan 17, 2007

Last updated

Jun 2, 2008By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Louisville School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physical Therapy Associates, IncGroup PAC ID 4880591270, 17 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physical Therapy Associates, Inc

  • Physical Therapist
  • Elizabethtown, KY
  • NPI 1336246412
  Medicare reassignment Care Compare group NPD
• Physical Therapy Associates Inc

  • Physical Therapist
  • Mt Washington, KY
  • NPI 1902770530
  NPD Authorized official
• Physical Therapy Associates Inc

  • Physical Therapist
  • Brandenburg, KY
  • NPI 1487001384
  NPD (past) Authorized official
• Physical Therapy Associates, Inc

  • Physical Therapist
  • Radcliff, KY
  • NPI 1992911960
  NPD
• A.M. Faheem, M.D., P.S.C.

  • Specialist
  • Elizabethtown, KY
  • NPI 1932266947
  NPD (past)
• Neurosurgery PSC

  • Neurological Surgery Physician
  • Hopkinsville, KY
  • NPI 1033122064
  NPD (past)
• Physical Therapy Associates Inc

  • Physical Therapist
  • Hodgenville, KY
  • NPI 1366658106
  NPD (past)
• Physical Therapy Associates, Inc.

  • Physical Therapist
  • Bardstown, KY
  • NPI 1912157520
  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1477605772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 N MILES ST",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427011834",
            "telephone_number": "270-360-9129",
            "fax_number": "270-234-8197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 WOODLAND DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012710",
            "telephone_number": "270-234-1569",
            "fax_number": "270-234-0680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GUY",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "002884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87000048",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000176410",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "2439083000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #02225)
• Marcy N Walker
• Tammy Walker
• Victoria Lynn Walker, APSS
• Deborah A Wall
• Tiffani Romayne Wallace
• Travis J Walline, D.C.
• Laura Michelle Walsh
• Patrick J Walsh, APSS
• Venda Rogers Walter

• Physical Therapist in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.