Alicia A Wallace, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A1345 Issued in MN

Practice address

1861 Eagle View Cir
Albert Lea, MN 56007-1818

Phone

(507) 373-2040

NPI assigned

Jan 11, 2022

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1952052060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "GENEVA",
            "state": "MN",
            "postal_code": "560350277",
            "telephone_number": "507-383-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1861 EAGLE VIEW CIR",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560071818",
            "telephone_number": "507-373-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALICIA",
        "middle_name": "A",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A1345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF MINNESOTA",
            "identifier": "A1345",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julian Richard Waggoner III, M.D.
• Wal-Mart Stores, Inc.
• Walgreen Co
• Howard James Walker, PH.D.
• Wendy Elizabeth Walker, MS
• Walmart Inc.
• Ying Wang, M.D.
• Annette Marlene Warner, LICSW
• Water Street Psychology
• Shaina Rae Watson, APRN, NP-C

• Physical Therapy Assistant in Albert Lea, MN
• Providers in Albert Lea, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.