Nicole Lee Wallace, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2025036692 Issued in MO

Practice address

1531 E Bradford Pkwy Ste 210-4
Springfield, MO 65804-6539

Phone

(417) 881-9500

NPI assigned

Aug 27, 2026

Last updated

Aug 27, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Lee Woolbright Former name

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": "1787788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1619884186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 E BRADFORD PKWY STE 210-4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 E BRADFORD PKWY STE 210-4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046539",
            "telephone_number": "417-881-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NICOLE",
        "middle_name": "LEE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-08-27",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2025036692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "WOOLBRIGHT",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hannah L Wallace, MS, BCBA
• Karen Wallace
• Kevin D Wallace, DMD PC
• Lacey Jo Wallace, MS, PLPC
• Morgan Dawn Wallace, PA-C
• Samantha Wallace, DO
• Sherrie K Wallace, MSW, LCSW
• Wayne Wallender, D.O.
• Scott Winters Wallentine, DPT
• Taylor Waller

• Physical Therapy Assistant in Springfield, MO
• Providers in Springfield, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.