Active NPI
Christopher Wall, PTA
- Physical Therapy Assistant
- Indialantic, FL
National Provider Identifier
1770199838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA30410
- Practice address
- 130 Hacienda
Indialantic, FL 32903-2835 - Phone
- (321) 456-7883
- NPI assigned
- Sep 23, 2020
- Last updated
- Sep 23, 2020
- Sex
- Male
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | PTA30410 | FL | Primary |
Addresses
Primary practice location
130 Hacienda
Indialantic, FL 32903-2835
Mailing address
130 Hacienda
Indialantic, FL 32903-2835
Phone (321) 456-7883
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA30410 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600819200000",
"number": "1770199838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 HACIENDA",
"city": "INDIALANTIC",
"state": "FL",
"postal_code": "329032835",
"telephone_number": "321-456-7883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 HACIENDA",
"city": "INDIALANTIC",
"state": "FL",
"postal_code": "329032835",
"telephone_number": "321-456-7883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "CHRISTOPHER",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-23",
"last_updated": "2020-09-23",
"certification_date": "2020-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA30410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indialantic, FL
- Viera Psychological Services PA
- Nevin Vijayaraghavan, DO
- Virginia McCarley, LMHC LLC
- Vitacore Medical Group, PLLC
- Mark A Vuletich, D.O.
- William Steele Warden, M.D.
- Shiloh Webb, FNP-C
- Weidenbenner Counseling & Consulting Services LLC. (Ascent Counseling Services)
- Kerstin Welch, LCSW
- Jaime Wiens, PHARMD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.