David R Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT2738 Issued in MS

Practice address

2170 S Lamar Blvd
Oxford, MS 38655-5224

Phone

(662) 234-8559

Fax

(662) 234-7923

NPI assigned

Apr 23, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Professional Therapy Services Inc

  • Physical Therapist
  • Tuscaloosa, AL
  • NPI 1851462485
  NPD (past)

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240444800000",
    "number": "1760626576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 S. LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "38655",
            "telephone_number": "662-234-8559",
            "fax_number": "662-234-7923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 S LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555224",
            "telephone_number": "662-234-8559",
            "fax_number": "662-234-7923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-23",
        "last_updated": "2009-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT2738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Larsen Walker, MS, CMHT
• Nyesha Walker
• Brian Keith Wall, MD
• April Reed Wallace, CCC-SLP
• Ashlee Wallace, RN
• Walter Moore Wallace, L.C.S.W.
• Jason Waller, DO
• Waller'S Discount Drugs, Inc.
• Ryan Shelton Wally, O.D.
• Joshua M Walston

• Physical Therapist in Oxford, MS
• Providers in Oxford, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; 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.