Active NPI
Jason Scott Wallace, PTA
- Physical Therapy Assistant
- Camarillo, CA
National Provider Identifier
1891786646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- AT5146
- Practice address
- 2486 N Ponderosa Dr
Ste D-106
Camarillo, CA 93010-2376 - Phone
- (805) 484-5447
- NPI assigned
- Nov 1, 2005
- Sex
- Male
- 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 | AT5146 | CA | Primary |
Addresses
Primary practice location
2486 N Ponderosa Dr
Ste D-106
Camarillo, CA 93010-2376
Mailing address
4979 Burson Way
Oxnard, CA 93036-1017
Phone (805) 671-5625
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 |
|---|---|---|---|
| AT5146 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1891786646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4979 BURSON WAY",
"city": "OXNARD",
"state": "CA",
"postal_code": "930361017",
"telephone_number": "805-671-5625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2486 N PONDEROSA DR",
"address_2": "STE D-106",
"city": "CAMARILLO",
"state": "CA",
"postal_code": "930102376",
"telephone_number": "805-484-5447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JASON",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-01",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "AT5146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camarillo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.