Active NPI
Jessica Wallace
- Physical Therapist
- La Plata, MD
National Provider Identifier
1760206460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 101 Centennial St Ste C
La Plata, MD 20646-5976 - Phone
- (301) 392-3700
- NPI assigned
- Nov 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
101 Centennial St Ste C
La Plata, MD 20646-5976
Mailing address
1911 S 21St St
Rogers, AR 72758-6101
Phone (479) 270-0588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
101 Centennial St
Suite C
La Plata, MD 20646-5976
Phone (301) 392-3700
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Plata Physical Therapy | Physical Therapist | Current | Accepting new patients |
| La Plata Physical Therapy | Past | Accepting new patients |
Locations
101 Centennial St
Ste C
La Plata, MD 20646
Phone (301) 392-3700
Organizations & group practices 2
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.
-
- Physical Medicine & Rehabilitation Physician
- La Plata, MD
- NPI 1376731026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1760206460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1911 S 21ST ST",
"city": "ROGERS",
"state": "AR",
"postal_code": "727586101",
"telephone_number": "479-270-0588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CENTENNIAL ST STE C",
"city": "LA PLATA",
"state": "MD",
"postal_code": "206465976",
"telephone_number": "301-392-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-11",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Plata, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.