Grace Wallace, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501018654 Issued in MI

Practice address

550 Munson Ave
Traverse City, MI 49686-3580

Phone

(231) 935-8659

NPI assigned

Dec 3, 2018

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

Other names 1

• Grace Blankenhagen Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: gwallace548511@direct.med.utah.edu

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1851861850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 6TH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 MUNSON AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863580",
            "telephone_number": "231-935-8659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GRACE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-03",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "GWALLACE548511@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "BLANKENHAGEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Craig Michael Walker, RPH
• David Alan Walker, D.O.
• M Marie Walker
• Christine E Walkowiak, PA
• Kyle Mark Walkowiak, PA-C
• Randall Thomas Wallace
• Chelsey Ann Waller, CNM, WHNP
• Melissa Wallington, OTR/L
• Katheryn Rae Wallison
• Christina Jean Walsh, MSW

• Physical Therapist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.