Mara Wallisch, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

LPT-31418 Issued in AZ

Practice address

1640 E River Rd Ste 110
Tucson, AZ 85718-7645

Phone

(520) 729-1960

NPI assigned

Apr 15, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bodycentral Physical Therapy PCGroup PAC ID 2466348701, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bodycentral Physical Therapy P C

  • Physical Therapy Clinic/Center
  • Tucson, AZ
  • NPI 1629057930
  Medicare reassignment Care Compare group NPD
• Bodycentral Physical Therapy PC

  • Customized Equipment (DME)
  • Tucson, AZ
  • NPI 1780899369
  NPD

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1780327908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4321 N RIO CANCION APT 219",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857187124",
            "telephone_number": "908-644-3241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 E RIVER RD STE 110",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857187645",
            "telephone_number": "520-729-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLISCH",
        "first_name": "MARA",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-31418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "securerecords.sanford.html",
            "affiliation": "N",
            "address_1": "1640 E River Rd Ste 110",
            "city": "Tucson",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "857187645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Candice Waller, LPC-MHSP
• Kurt David Wallin, D.M.D.
• Salley A Wallin, LCSW, MSW
• Corinne Elizabeth Wallis, PT, DPT
• Helena Wallis, LMT
• Chloe Grace Walls, DMD
• Walmart
• Walmart Inc
• Walmart Inc.
• Walmart Inc.

• Physical Therapist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.

Verify at the official NPI Registry.