Sophia Wallace

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

830 29TH St, Orlando, FL 32805
Orlando, FL 32805

Phone

(407) 843-3230

NPI assigned

Feb 21, 2023

Last updated

Feb 21, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1689372419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 COMPASS RD",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600268001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 29TH ST, ORLANDO, FL 32805",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32805",
            "telephone_number": "407-843-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SOPHIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-21",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eveline S. Wallace, ARNP
• Joy Wallace, CNM
• Racquel Wallace, APRN
• Shawna Nicole Wallace, M.A.
• Simone Alisha Wallace, OD
• Tashoy M Wallace, APRN
• Michelle Ferrer Wallen, D.O.
• Ashley Waller
• Helen Waller, BS
• Justin Blaine Waller, OD

• Physical Therapy Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; 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.