Lauren Nicole Waller

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

3400 Alta Arden Expy
Sacramento, CA 95825-2103

Phone

(916) 481-5500

NPI assigned

May 21, 2019

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": "1558396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1720645229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 OAKWOOD BLVD STE 130",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330201937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 ALTA ARDEN EXPY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958252103",
            "telephone_number": "916-481-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "LAUREN",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-21",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomisha Wallace
• Tina Wallace
• Trevor B. Wallace, MFTI/IMF
• Stacey J. Wallach, M.D.
• Tracy Wallen
• Kyn Barnard Wallick, B.A.
• Kelly J Wallin
• Casey Walline
• Mystery Wallis
• Trisha Dianne Wallis, MSW, LCSW, PSYD

• Physical Therapy Assistant in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.