Active NPI
William Todd Wallace, PT
- Physical Therapist
- Texarkana, TX
National Provider Identifier
1598028474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1097046
- Practice address
- 8225 Coyote TRL
Texarkana, TX 75503-9657 - Phone
- (903) 223-6942
- NPI assigned
- Jun 16, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | 1097046 | TX | Primary |
Addresses
Primary practice location
8225 Coyote TRL
Texarkana, TX 75503-9657
Mailing address
8225 Coyote TRL
Texarkana, TX 75503-9657
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1097046 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339804800000",
"number": "1598028474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8225 COYOTE TRL",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755039657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8225 COYOTE TRL",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755039657",
"telephone_number": "903-223-6942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "WILLIAM",
"middle_name": "TODD",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-16",
"last_updated": "2012-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1097046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.