Active NPI
Randall Allen Wallace, P.T.
- Ergonomics Physical Therapist
- Oaklahoma City, OK
National Provider Identifier
1497820252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ergonomics Physical Therapist
- License
- PT2855
- Practice address
- 409 E. California Ave.
Oaklahoma City, OK 73104 - Phone
- (405) 879-6766
- Fax
- (405) 879-3493
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2855 | OK | |
| Ergonomics Physical Therapist | 2251E1200X | PT2855 | OK | Primary |
Addresses
Primary practice location
409 E. California Ave.
Oaklahoma City, OK 73104
Mailing address
18305 English Oak LN
Edmond, OK 73003-4051
Phone (405) 216-8731
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT2855 | OK | MD | Physical Therapist |
| 2855 | OK | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Functional Assestment Centers of Oklahoma | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapy Clinic/Center
- Oklahoma City, OK
- NPI 1952475154
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1497820252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18305 ENGLISH OAK LN",
"city": "EDMOND",
"state": "OK",
"postal_code": "730034051",
"telephone_number": "405-216-8731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 E. CALIFORNIA AVE.",
"city": "OAKLAHOMA CITY",
"state": "OK",
"postal_code": "73104",
"telephone_number": "405-879-6766",
"fax_number": "405-879-3493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "RANDALL",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "PT2855",
"primary": false
},
{
"code": "2251E1200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Ergonomics",
"state": "OK",
"license": "PT2855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oaklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.