Shawnly Elise Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00005001 Issued in WA

Practice address

4020 S 56TH St Ste 101
Tacoma, WA 98409-2626

Phone

(253) 475-6862

NPI assigned

May 23, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619187788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25813 68TH AVE E",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983387133",
            "telephone_number": "253-820-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 S 56TH ST STE 101",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984092626",
            "telephone_number": "253-475-6862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHAWNLY",
        "middle_name": "ELISE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00005001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT00005001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Wall
• Alecia Dawn Wallace, RDH
• Jeanette Wallace, RPH
• Paul Wayne Wallace, PHARMD
• Renee Elizabeth Wallace
• Shelley Renee Wallace, MPH, RD, CN
• Stephanie Ellen Wallace, MD
• Theodore William Wallace, PA-C
• Winona Ann Wallace, LMHC
• Tate Wallar

• Physical Therapist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.