Active NPI
Lisa N. Wallace, LPTA
- Physical Therapy Assistant
- Lagrange, GA
National Provider Identifier
1801099767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA000264
- Practice address
- 1514 Vernon Rd
Lagrange, GA 30240-4131 - Phone
- (706) 845-3192
- Fax
- (706) 845-3700
- NPI assigned
- Jun 7, 2007
- Sex
- Female
- 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 | PTA000264 | GA | Primary |
Addresses
Primary practice location
1514 Vernon Rd
Lagrange, GA 30240-4131
Mailing address
536 Pine Ave
Roanoke, AL 36274-1446
Phone (334) 863-6844
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 |
|---|---|---|---|
| PTA000264 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801099767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "536 PINE AVE",
"city": "ROANOKE",
"state": "AL",
"postal_code": "362741446",
"telephone_number": "334-863-6844",
"fax_number": "706-845-3700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 VERNON RD",
"city": "LAGRANGE",
"state": "GA",
"postal_code": "302404131",
"telephone_number": "706-845-3192",
"fax_number": "706-845-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LISA",
"middle_name": "N.",
"name_prefix": "Mrs.",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA000264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lagrange, GA
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0614)
- Wal-Mart Stores East LP (Walmart Pharmacy 10-2773)
- Wal-Mart Stores East, LP. (Walmart pharmacy 10-3164)
- Walgreen Co (Rite Aid #11769)
- Walgreen Co (Walgreens #09622)
- Amanda Howington Ward, PHYSICIAN ASSISTANT
- Kevin R Ward, CRNP
- Alfred Antonio Ware, NEMT
- Amy Melissa Ware, PP
- Laqua'Sha Monique Warren, MSN, APRN, FNP-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.