Gary Robert Wallace, PTA

Physical Therapy Assistant · Jackson, MS

Individual Active NPI

NPI number 1003009184

Practice location

13 Northtown Dr
Trinity Rehab Suite 110
Jackson, MS 39211
Phone
(601) 206-9195
Fax
(601) 957-8391

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NPI record

NPI
1003009184
Entity type
Individual (Type 1)
Enumeration date
August 22, 2007
Last updated
August 22, 2007
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physical Therapy Assistant Primary 225200000X A2636 LA

Mailing address

13 Northtown Dr
Suite 110 Trinity Rehab
Jackson, MS 39211
Phone
(601) 206-9195
Fax
(601) 957-8391

About Gary Wallace

Gary Robert Wallace, PTA is a healthcare provider registered in the NPI registry with the primary taxonomy Physical Therapy Assistant (code 225200000X). The practice location is 13 Northtown Dr, Trinity Rehab Suite 110, Jackson, MS 39211. The NPI number 1003009184 was assigned on August 22, 2007 and the record was last updated on August 22, 2007.

Gary Wallace lists a license in the registry: #A2636 (LA) for Physical Therapy Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Gary Robert Wallace, PTA?

The NPI number is 1003009184.

What is the phone number of Gary Wallace?

The phone number listed for the practice location is (601) 206-9195.

Where is Gary Wallace located?

13 Northtown Dr, Trinity Rehab Suite 110, Jackson, MS 39211.

What is the taxonomy code for Gary Wallace?

The primary taxonomy code is 225200000X – Physical Therapy Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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