Christopher George Wallace, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OC017968 Issued in PA

Practice address

6595 Roosevelt Blvd
Philadelphia, PA 19149-2998

Phone

(215) 743-2332

NPI assigned

Sep 1, 2021

Sex

Male

Sole proprietor

Yes

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

Enrolled in PA

Enrollment records 1

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.

• Rehabclinics (SPT), Inc.

  dba NovaCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Conshohocken, PA
  • NPI 1255330148
  Medicare reassignment NPD
• Rehabclinics (SPT), Inc.

  dba NovaCare Rehabilitation

  • Rehabilitation Clinic/Center
  • Bensalem, PA
  • NPI 1902453343
  NPD
• Rehabclinics SPT, Inc.

  dba NovaCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Chalfont, PA
  • NPI 1952009482
  NPD

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1629746904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HAINES DR",
            "city": "NORTH WALES",
            "state": "PA",
            "postal_code": "194542702",
            "telephone_number": "215-360-9314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6595 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492998",
            "telephone_number": "215-743-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHRISTOPHER",
        "middle_name": "GEORGE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC017968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Lucas Wall
• Sara Elizabeth Wallace-Keeshen, FNP-BC
• Andre Lamar Wallace
• Arlene Denise Wallace, EDD
• Christopher Wallace, PT, DPT
• Dana Marie Wallace, CRNP FNP-C
• Dashiya Wallace
• Dylan Elizabeth Wallace, FNP
• Emily Wallace, RDN
• Fiona Marcia Wallace, M.S.

• Occupational Therapist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Occupational Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.