Active NPI
William C Wallace, PT
- Physical Therapist
- Lebanon, TN
National Provider Identifier
1508880493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 4793
- Practice address
- 1113 N Castle Heights Ave
Suite D
Lebanon, TN 37087-5640 - Phone
- (615) 965-9000
- Fax
- (615) 965-9001
- NPI assigned
- Jul 26, 2006
- Last updated
- Jun 7, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 4793 | TN | Primary |
Addresses
Primary practice location
1113 N Castle Heights Ave
Suite D
Lebanon, TN 37087-5640
Mailing address
1113 N Castle Heights Ave
Suite D
Lebanon, TN 37087-5640
Phone (615) 965-9000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4793 | Other | TN | PT LICENSE |
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 |
|---|---|---|---|
| PT 4793 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370563200000",
"number": "1508880493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1113 N CASTLE HEIGHTS AVE",
"address_2": "SUITE D",
"city": "LEBANON",
"state": "TN",
"postal_code": "370875640",
"telephone_number": "615-965-9000",
"fax_number": "615-965-9001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1113 N CASTLE HEIGHTS AVE",
"address_2": "SUITE D",
"city": "LEBANON",
"state": "TN",
"postal_code": "370875640",
"telephone_number": "615-965-9000",
"fax_number": "615-965-9001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "WILLIAM",
"middle_name": "C",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2013-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "PT 4793",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "4793",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.