Madisen Wallace, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT021082 Issued in OH

Practice address

3477 S Dixie Hwy
Lima, OH 45804-3706

Phone

(567) 356-4385

Fax

(419) 738-8002

NPI assigned

May 17, 2024

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

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Back on Track Therapy and Wellness, LLCGroup PAC ID 0749524775, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Back on Track Therapy and Wellness, LLC

  • Physical Therapist
  • Lima, OH
  • NPI 1043739436
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1715904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715990400000",
    "number": "1821847153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3477 S DIXIE HWY",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458043706",
            "telephone_number": "567-356-4385",
            "fax_number": "419-738-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3477 S DIXIE HWY",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458043706",
            "telephone_number": "567-356-4385",
            "fax_number": "419-738-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MADISEN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-17",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT021082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina M Walker, LCDCIII
• Kristi Walker, PHARMD
• Megan Walker
• Sheila D Walker
• Jessica Anne Walkup
• Rachel L Wallace, ATC
• Sandra Wallen
• Jessica Walles, PHARM.D.
• Jacob Blake Walling, MD
• Danielle Marie Walpole, CDCA

• Physical Therapist in Lima, OH
• Providers in Lima, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; 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.