Jill Wallace, PT
Physical Therapist in Waukesha, WI. Individual provider (NPI-1).
NPI number1104883099
StatusActive
Last updated in NPPESJan 18, 2012
Details
- NPI
- 1104883099
- Entity type
- Individual (NPI-1)
- Name
- Jill Wallace
- Credential
- PT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 26, 2006
- Last updated
- Jan 18, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 10232 | WI | Yes |
Practice location
W239n1812 Rockwood Dr Ste 100Phcma INC.
Waukesha, WI 53188-1113
Phone 262-523-0310
Mailing address
W239n1812 Rockwood Dr Ste 100Phcma INC.
Waukesha, WI 53188-1113
Phone 262-523-0310
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 98 Physical Therapist providers in Waukesha · All 3,394 providers in Waukesha
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