Edwin Rush Wallace III, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP031482T Issued in NJ

Practice address

100 Plainsboro Rd
Plainsboro, NJ 08536-1914

Phone

(571) 370-3686

Fax

(571) 370-3687

NPI assigned

Dec 7, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

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.

• Sportscare of America, PC

  • Physical Therapist
  • East Hanover, NJ
  • NPI 1851484380
  Medicare reassignment NPD
• United Sports Care & Physical Therapy

  • Occupational Therapist
  • Cedar Knolls, NJ
  • NPI 1972881233

  Physical Therapist

  Medicare reassignment NPD
• Jackson Clinics Limited Partnership

  • Physical Therapist
  • Centreville, VA
  • NPI 1639594831
  NPD
• Bethann Wallace

  • Physical Therapist
  • Staunton, VA
  • NPI 1396809125
  NPD (past)

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1790968154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PLAINSBORO RD",
            "city": "PLAINSBORO",
            "state": "NJ",
            "postal_code": "085361914",
            "telephone_number": "609-945-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PLAINSBORO RD",
            "city": "PLAINSBORO",
            "state": "NJ",
            "postal_code": "085361914",
            "telephone_number": "571-370-3686",
            "fax_number": "571-370-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "EDWIN",
        "middle_name": "RUSH",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-07",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "CP031482T",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305005465",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Valenziano
• Yvonne P Van Bochove, PT,DPT,MA
• Yashia Vargas, LCSW
• Camille Denise Vaughn
• Yuliya Voznyuk, APN
• Wallop Inc
• Qian Wang, MD
• Steve Shiyann Wang, PH.D
• Zoe Anne Wasserman, DNP, CNM, WHNP
• Lloyd Antoine Webster Jr., M.D.

• Physical Therapist in Plainsboro, NJ
• Providers in Plainsboro, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.