GARY ROBERT WALLACE (NPI# 1003009184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003009184 |
| Entity Type | Individual |
| Full Name | GARY ROBERT WALLACE |
| Credential | PTA |
| Practice Address |
13 Northtown Dr Trinity Rehab Suite 110 Jackson MS 39211 |
| Mailing Address |
13 Northtown Dr Suite 110 Trinity Rehab Jackson MS 39211 |
| Practice Telephone | 6012069195 |
| Practice Fax Number | 6019578391 |
| Mailing Telephone | 6012069195 |
| Mailing Fax Number | 6019578391 |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225200000X | Physical Therapy Assistant | A2636 | LA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144335290 | Gary Wayne Wallace | Ophthalmology | 2295 Coronado Street, Idaho Falls, ID 83404 | 2006-08-20 |
| 1427083633 | Gary S Wallace | Family Medicine | 2550 E Guadalupe, #107, Gilbert, AZ 85234 | 2006-07-12 |
| 1962484634 | Gary Rhett Wallace | Family Medicine | Bldg 5-4257, Bastogne Extension, Fort Bragg, NC 28310-0001 | 2005-11-17 |
| Street Address |
13 NORTHTOWN DR TRINITY REHAB SUITE 110 |
| City | JACKSON |
| State | MS |
| Zip Code | 39211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548218738 | Providence Hospice, LLC | Hospice Care, Community Based | 13 Northtown Dr, Suite 220, Jackson, MS 39211-3047 | 2006-05-04 |
| 1093251845 | Reliant Medical Transportation, LLC | Ambulance | 13 Northtown Dr, Suite 130, Jackson, MS 39211-3047 | 2017-01-17 |
| 1891169496 | Quitman County Health & Rehab, LLC | Nursing Facility/Intermediate Care Facility | 13 Northtown Dr, Suite 220, Jackson, MS 39211-3047 | 2015-11-19 |
| 1598139248 | Tunica County Health & Rehab, LLC | Nursing Facility/Intermediate Care Facility | 13 Northtown Dr, Suite 220, Jackson, MS 39211-3047 | 2015-11-18 |
| 1932571296 | H & R Healthcare, LLC | Skilled Nursing Facility | 13 Northtown Dr, Suite 220, Jackson, MS 39211-3047 | 2015-10-27 |
| 1295174316 | Laura Catherine Weeks | Occupational Therapist | 13 Northtown Dr, Suite 110, Jackson, MS 39211-3047 | 2013-06-21 |
| 1902030026 | Sharon Gayle Magee | Occupational Therapist | 13 Northtown Dr, Suite 110, Jackson, MS 39211-3047 | 2009-05-04 |
| 1275727422 | Steven Patrick Moore | Physical Therapist | 13 Northtown Dr, Suite 110, Jackson, MS 39211-3047 | 2007-08-30 |
| 1184818577 | Danielle Marie Butkowski | Occupational Therapist | 13 Northtown Dr, Suite 110, Jackson, MS 39211-3047 | 2007-08-29 |
| 1881888279 | Alicia M Marlow | Speech-Language Pathologist | 13 Northtown Dr, Suite 110, Jackson, MS 39211-3047 | 2007-08-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760092878 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 5722 I-55 N Frontage Road, Jackson, MS 39211 | 2020-08-04 |
| 1548881048 | Gloria Dansby-giles | Counselor | 4500 Interstate 55, North; Suite 220, Jackson, MS 39211 | 2020-05-06 |
| 1821628223 | Alice Powell Taylor | St. Dominic Weight Loss Solutions, 3800 Interstate 55 North Frontage Road Suite 102, Jackson, MS 39211 | 2020-01-24 | |
| 1356980643 | Bethany Powers | Pharmacist | 4910 Interstate 55 North Frontage Rd, Jackson, MS 39211 | 2020-01-03 |
| 1316585581 | Deborah Magoun Rosenbaum | Pharmacist | [email protected], 4910 I-55 North, Jackson, MS 39211 | 2019-12-18 |
| 1285108357 | Eric Wood | Counselor | 4623 Maurey Rd, Jackson, MS 39211 | 2019-01-11 |
| 1649758301 | Isluv Robertson | Registered Nurse | 1405 E Northside Dr, Jackson, MS 39211 | 2018-08-03 |
| 1659863066 | Jonbrighton Childs Russell | Student in an Organized Health Care Education/Training Program | 4343 Dalrymple Ct, Jackson, MS 39211 | 2018-05-31 |
| 1225557598 | Regina Ann Day | Dietitian, Registered | 3800 I 55 North Frontage Road, Jackson, MS 39211 | 2017-09-18 |
| 1023558525 | Agilitas Usa Inc | Clinic/Center | 120 District Blvd E, Suite D102, Jackson, MS 39211 | 2017-03-02 |
| Find all providers in zip 39211 | ||||
| Taxonomy Code | 225200000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapy Assistant |
| (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of the physical therapist assistant. The PTA performs physical therapy procedures and related tasks that have been selected and delegated by the supervising physical therapist. Duties of the PTA include assisting the physical therapist in implementing treatment programs, training patients in exercised and activities of daily living, conducting treatments, and reporting to the physical therapist on the patient’s responses. In addition to direct patient care, the PTA may also perform such functions as patient transport, and clinic or equipment preparation and maintenance. Currently more than half of all states require PTAs to be licensed, registered or certified. (2) An individual who works under the supervision of a physical therapist to assist him or her in providing physical therapy services. A physical therapy assistant may, for instance, help patients follow an appropriate exercise program that will increase their strength, endurance, coordination, and range of motion and train patients to perform activities of daily life. |
| Notes: Source: (1) American Physical Therapy Association, P.O. Box 37257, Washington, D.C. 20013. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023641446 | Andreanna Gibbs | Physical Therapy Assistant | 100 Hwy 15, Jackson, KY 41339 | 2020-02-13 |
| 1568094811 | Michelle Lynn Dominick-dreyer | Physical Therapy Assistant | 4431 Bonnymede St, Jackson, MI 49201-8511 | 2020-02-05 |
| 1548810682 | Morgan E. Martin | Physical Therapy Assistant | 2142 Horton Rd, Jackson, MI 49203-5524 | 2019-09-19 |
| 1720638968 | Tara Jo Beebe | Physical Therapy Assistant | 3076 Hendee Rd, Jackson, MI 49201-9001 | 2019-09-19 |
| 1376190488 | Srilatha Mittapelli | Physical Therapy Assistant | 4605 Eagle Dr, Jackson, MI 49201-9747 | 2019-08-22 |
| 1831667864 | Kylie B Seyer | Physical Therapy Assistant | 121 Pinecrest, Jackson, MO 63755-8465 | 2018-11-07 |
| 1528558392 | Darlene Childers | Physical Therapy Assistant | 2700 Canoe Rd, Jackson, KY 41339-8458 | 2018-05-16 |
| 1154863454 | Gavin Blackwell | Physical Therapy Assistant | 115 Quail Rdg, Jackson, TN 38305-5420 | 2016-11-17 |
| 1881077436 | Natalie Stephens | Physical Therapy Assistant | 768 Miller Ave, Jackson, NJ 08527-3546 | 2015-07-01 |
| 1366856924 | Levella Kelly | Physical Therapy Assistant | 3856 Noble St, Apt 811, Jackson, MS 39209-4954 | 2014-06-11 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.