Nicole Marie Wallace, PT

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

913 First Colonial Rd Ste 204
Virginia Beach, VA 23454-3198

Phone

(757) 550-0725

NPI assigned

May 8, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 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 and National Provider Directory roles.

• Legacy Healthcare Services Inc

  • Physical Therapist
  • Roanoke, VA
  • NPI 1740820828
  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services, Inc

  • Physical Therapist
  • Washington, DC
  • NPI 1255750030
  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1609089028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 FIRST COLONIAL RD STE 204",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543198",
            "telephone_number": "757-550-0725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 FIRST COLONIAL RD STE 204",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543198",
            "telephone_number": "757-550-0725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "VA",
            "license": "2305203070",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey L. Wallace, PT, DPT
• Cynthia Wallace, L.AC.
• Holly Wallace, M.ED., CCC-SLP
• Kiyosia Wallace
• Marsha Wallace
• Quanesha Wallace, LPC-R
• Shayla Wallace
• Tiffany Wallace, QMHP
• Ian T Walloch
• Kaitlin Suzanne Walsh, MSED

• Specialist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; 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.