Active NPI
Diana Wallace
- Physical Therapist
- Richmond, VA
National Provider Identifier
1891546727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305204230
- Practice address
- 1800 Gaskins Rd
Richmond, VA 23238-4324 - Phone
- (804) 998-3671
- NPI assigned
- Mar 28, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | 2305204230 | VA | Primary |
Addresses
Primary practice location
1800 Gaskins Rd
Richmond, VA 23238-4324
Mailing address
1800 Gaskins Rd
Richmond, VA 23238-4324
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305204230 | VA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711584000000",
"number": "1891546727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 GASKINS RD",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232384324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 GASKINS RD",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232384324",
"telephone_number": "804-998-3671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DIANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-28",
"last_updated": "2024-03-28",
"certification_date": "2024-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305204230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.