Individual provider
GARY ROBERT WALLACE, PTA
CMS NPPES lists GARY ROBERT WALLACE as an individual provider record with NPI 1003009184. The current record reports a primary practice location in JACKSON, MS and primary taxonomy code 225200000X.
Type 1 NPIs identify individual healthcare providers. How to read this profile
01
Practice locations
- Primary practice location13 NORTHTOWN DRTRINITY REHAB SUITE 110JACKSON, MS 39211
Only source-designated practice locations are shown here. Mailing addresses are not presented as practice locations.
02
Taxonomy information
225200000XPrimary reported taxonomy
Taxonomy codes describe provider classifications reported to NPPES. Repeated identical codes are shown once, with primary-reported status preserved. They are not licenses, certifications, quality measures, or NPIFolio specialty labels. Read the taxonomy methodology.
03
NPI record information
- NPI status
- Enumerated in NPPES
- Enumeration date
- August 22, 2007
An NPI is a federal identifier. Enumeration and lifecycle information does not establish medical-license status, current practice, disciplinary history, provider quality, or whether a provider is accepting patients.