Devon Wallace, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305211669 Issued in VA

Practice address

101 W 14TH St
Front Royal, VA 22630-3607

Phone

(540) 636-3500

Fax

(540) 636-3502

NPI assigned

Dec 20, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

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

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1770099244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 PLAZA DR",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226016365",
            "telephone_number": "540-665-2750",
            "fax_number": "540-665-2749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 14TH ST",
            "city": "FRONT ROYAL",
            "state": "VA",
            "postal_code": "226303607",
            "telephone_number": "540-636-3500",
            "fax_number": "540-636-3502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14370 Lee Hwy Ste 104",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "VA",
            "postal_code": "201554865",
            "country_code": "US",
            "telephone_number": "703-754-4450",
            "fax_number": "703-754-4454",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1808 Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Winchester",
            "state": "VA",
            "postal_code": "226016365",
            "country_code": "US",
            "telephone_number": "540-665-2750",
            "fax_number": "540-665-2749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DEVON",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Front Royal, VA
• Providers in Front Royal, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.