Active NPI
Ian Carroll Wallace, PT
- Physical Therapist
- Houston, TX
National Provider Identifier
1982346722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1220166
- Practice address
- 10125 Katy Fwy Ste 100
Houston, TX 77024-1287 - Phone
- (713) 984-6270
- Fax
- (713) 242-3931
- NPI assigned
- Apr 12, 2022
- 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 Therapist | 225100000X | 1220166 | TX | Primary |
Addresses
Primary practice location
10125 Katy Fwy Ste 100
Houston, TX 77024-1287
Mailing address
2314 Willow Cove Dr
Rosharon, TX 77583-3227
Phone (832) 483-4291
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 |
|---|---|---|---|
| 1220166 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649721600000",
"number": "1982346722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2314 WILLOW COVE DR",
"city": "ROSHARON",
"state": "TX",
"postal_code": "775833227",
"telephone_number": "832-483-4291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10125 KATY FWY STE 100",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770241287",
"telephone_number": "713-984-6270",
"fax_number": "713-242-3931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "IAN",
"middle_name": "CARROLL",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-12",
"last_updated": "2022-04-12",
"certification_date": "2022-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1220166",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.