Amanda Wallace, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

08545 Issued in LA

Practice address

2115 Dulles Dr
Lafayette, LA 70506-2652

Phone

(337) 981-9182

NPI assigned

Apr 18, 2017

Sex

Female

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

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 and National Provider Directory roles.

• McLeod-Trahan-Sheffield Physical Therapy Services, Inc.

  • Physical Therapy Clinic/Center
  • Lafayette, LA
  • NPI 1245209436

  Physical Therapist

  NPD
• Acadiana Physical Therapy, Inc.

  • Physical Therapist
  • Lafayette, LA
  • NPI 1730139858
  NPD (past)

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492473600000",
    "number": "1578097341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 STABLE CREEK DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705065021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 DULLES DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705062652",
            "telephone_number": "337-981-9182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-18",
        "last_updated": "2017-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "08545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Jermaine Walker Sr., RSW
• Dominique Walker
• Lauren Walker
• Matthew Luther Walker, PT
• Shaun Walker, DO
• Dana Wallace, PHD, LPC-S, NCC
• Dionne Wallace
• Eli William Wallace, OT
• Maria Hebert Wallace, LCSW
• Sarah L Wallace, NP

• Physical Therapist in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.