Marisa Wallace, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P21665 Issued in NC

Practice address

14057 US Highway 17 Ste 230
Hampstead, NC 28443-3999

Phone

(910) 821-3377

Fax

(910) 821-3380

NPI assigned

Sep 21, 2022

Last updated

Nov 21, 2025By the provider in NPPES

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 NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Zumbro and Connell IncGroup PAC ID 5698852499, 39 clinicians

Pender Pelvic Health and Therapy Services, LLCGroup PAC ID 3375929722, 5 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pender Pelvic Health and Therapy Services, LLC

  • Physical Therapy Clinic/Center
  • Hampstead, NC
  • NPI 1235713074

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Zumbro and Connell, Inc

  dba Bodies In Balance Physical Therapy

  • Physical Therapy Clinic/Center
  • Wilmington, NC
  • NPI 1750567889

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1861115362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5710 OLEANDER DRIVE STE 211",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035390",
            "telephone_number": "910-398-6301",
            "fax_number": "910-423-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14057 US HIGHWAY 17 STE 230",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284433999",
            "telephone_number": "910-821-3377",
            "fax_number": "910-821-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARISA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-21",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P21665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Village Pharmacy of Hampstead Inc (Village Pharmacy)
• Village Pharmacy of Hampstead Inc (Village Pharmacy)
• Breony Miller Vinson, PA-C
• Vital Wellness PLLC
• Preston Almand Walker Jr., LPT
• Brianna Walters, RBT
• William Turner Warsaw, RN
• Abigail Webster
• Sydney Wells
• Mackenzie V Wernicke

• Physical Therapist in Hampstead, NC
• Providers in Hampstead, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; 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.