Wallace Physical Therapy, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

017462-1 Issued in NY

Legal business name

WALLACE PHYSICAL THERAPY, PLLC

Practice address

59A James St
Homer, NY 13077-1222

Phone

(315) 416-4327

Fax

(607) 749-5618

NPI assigned

Jul 15, 2006

Last updated

Sep 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandi H Wallace, PTNPI 1255351813

Title

President

Phone

(315) 416-4327

Specialties & licenses 1

Addresses

Other identifiers 4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sandi H Wallace, PT

  • Physical Therapist
  • Homer, NY
  • NPI 1255351813
  NPD (past) Authorized official

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1992721450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59A JAMES ST",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130771222",
            "telephone_number": "315-416-4327",
            "fax_number": "607-749-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59A JAMES ST",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130771222",
            "telephone_number": "315-416-4327",
            "fax_number": "607-749-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SANDI",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-416-4327",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "017462-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02458611",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAR RAILROAD",
            "identifier": "P00162216",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "000158099",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "364724",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andras Szabo, MD
• Victoria B Thornton, MS, CCC-SLP
• Nicole C. Tinker
• Toner Therapeutic Massage
• Ashley C Vormwald, CCC-SLP
• Sandi H Wallace, PT
• Zoe Walters
• Amy L C White, OTR/L
• Words at Play LLC
• Carolyne Yonta, PA

• Physical Therapist in Homer, NY
• Providers in Homer, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.