Lawrence Wallace, MD, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11194 Issued in SC

Practice address

1021 2ND Ave N Ste 6
North Myrtle Beach, SC 29582-3200

Phone

(843) 286-5168

Fax

(844) 318-8980

NPI assigned

Sep 12, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Hand and Upper Extremity TherapyGroup PAC ID 3678904620, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Elite Hand and Upper Extremity Therapy

  • Hand Occupational Therapist
  • North Myrtle Beach, SC
  • NPI 1467086926
  Medicare reassignment Care Compare group NPD
• Orthopedics of Southwest Virginia, LLC

  • Orthopaedic Surgery Physician
  • Richlands, VA
  • NPI 1033147061
  NPD (past)

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1679567192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 2ND AVE N STE 6",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295823200",
            "telephone_number": "843-286-5168",
            "fax_number": "844-318-8980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 2ND AVE N STE 6",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295823200",
            "telephone_number": "843-286-5168",
            "fax_number": "844-318-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LAWRENCE",
        "name_prefix": "Mr.",
        "credential": "MD, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "PA",
            "license": "MD439714",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P2177",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "VA",
            "license": "0101234728",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "11194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010114446",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Walgreen Co
• Kayla Renee Walker
• Phyllis D Walker, P.T.
• Tonya Candice Weber
• David Mark Weitzman, M.D.
• Amy Michele Wendelowski, LPC
• Teresa Werner
• Aaron Brent Westerlund, O.D.

• Physical Therapist in North Myrtle Beach, SC
• Providers in North Myrtle Beach, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; 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.