MR. JAMES LEWIS WALLACE JR. (NPI# 1396891933) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396891933 |
| Entity Type | Individual |
| Full Name | MR. JAMES LEWIS WALLACE JR. |
| Credential | CPO |
| Practice Address |
1901 Brunswick Ave Suite 200 Charlotte NC 28207-2809 |
| Mailing Address |
Po Box 24905 Winston Salem NC 27114-4905 |
| Practice Telephone | 7043484488 |
| Practice Fax Number | 7043484496 |
| Mailing Telephone | 3363972165 |
| Mailing Fax Number | 3363972167 |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2010-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 224P00000X | Prosthetist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7795261 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083226005 | James D Wallace | Technician | 67 Don Dale Dr, Foster, WV 25081 | 2020-08-20 |
| 1982173571 | James Preston Wallace II | Clinic/Center | 6234 Castlegate Dr W Apt 8112, Castle Rock, CO 80108-8655 | 2018-11-13 |
| 1356686877 | James Steven Wallace | Physical Therapy Assistant | 449 Main St Apt 131, Anderson, IN 46016-1186 | 2012-12-10 |
| 1033400999 | James Wallace | Durable Medical Equipment & Medical Supplies | 593 Bramlett Way, Powder Springs, GA 30127 | 2011-04-27 |
| 1841591559 | James Leeman Wallace | Massage Therapist | 29650 Sw Courtside Dr, #14, Wilsonville, OR 97070-7482 | 2010-11-11 |
| 1992023212 | James Joseph Wallace | Specialist | 154 Sugar Cane Dr, Hartwell, GA 30643-8120 | 2010-05-11 |
| 1538338413 | James Christopher Wallace | Military Health Care Provider | Uss Ross, Ddg 71, Fpo, AE 09586-1288 | 2008-02-26 |
| 1568664274 | James Christopher Wallace | Emergency Medical Technician, Basic | Cgc Chase (whec-718) Fpo Ap 96662-3932 32nd St, San Diego, CA 92106 | 2007-06-04 |
| 1760683924 | James G Wallace Jr. | Family Medicine | 525 Jay Ave, Brewster, WA 98812-3403 | 2007-05-29 |
| 1922143882 | James B Wallace Jr. | Dentist | 6618 Fm 2100, Crosby, TX 77532 | 2007-02-20 |
| Street Address |
1901 BRUNSWICK AVE SUITE 200 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28207-2809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922048313 | Level Four Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 1901 Brunswick Ave, Suite 240, Charlotte, NC 28207-2809 | 2006-06-07 |
| 1992191001 | Jennifer Little | Physician Assistant | 1901 Brunswick Ave, Suite 200, Charlotte, NC 28207-2809 | 2015-04-15 |
| 1154765832 | Novant Medical Group Inc | Surgery | 1901 Brunswick Ave, Suite 200, Charlotte, NC 28207-2809 | 2013-04-24 |
| 1851609093 | Donald D. Fraser, M.d., P.a. | Clinic/Center | 1901 Brunswick Ave, Suite 240, Charlotte, NC 28207-2809 | 2010-09-22 |
| 1952533457 | Melanie H Brocato | Orthotist | 1901 Brunswick Ave, Suite 200, Charlotte, NC 28207-2809 | 2009-08-17 |
| 1912170119 | James Ziegler Appel IIi | Plastic Surgery | 1901 Brunswick Ave, Suite 200, Charlotte, NC 28207-2809 | 2008-04-08 |
| 1629264171 | Christina M Hinton | Prosthetist | 1901 Brunswick Ave, Suite 200, Charlotte, NC 28207-2809 | 2007-09-19 |
| 1073739991 | Alexander Rossitch | Dentist | 1901 Brunswick Ave, Suite 250, Charlotte, NC 28207-2809 | 2007-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
| 1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
| 1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
| 1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
| 1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
| 1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
| 1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| 1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
| 1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
| Find all providers in zip 28207 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407350507 | Performance Footcare | Orthotist | 2024 Randolph Rd, Charlotte, NC 28207-1216 | 2018-03-22 |
| 1437660834 | Christos George Lemonis | Orthotist | 10420 Park Rd Ste 100a, Charlotte, NC 28210-8501 | 2017-10-12 |
| 1821528373 | Brett Rosen | Orthotist | 309 S Sharon Amity Rd Ste 104, Charlotte, NC 28211-2886 | 2017-06-18 |
| 1518407402 | Kayla Damore | Orthotist | 1901 Brunswick Ave Ste 240, Charlotte, NC 28207-2807 | 2017-02-27 |
| 1851701544 | Megan Marie Olivo | Orthotist | 1228 E Morehead St, Suite 100, Charlotte, NC 28204-2889 | 2014-05-02 |
| 1558797811 | Tyler Dunham | Orthotist | 309 S. Sharon Amity Road, Suite 104, Charlotte, NC 28211-2886 | 2013-09-18 |
| 1891032587 | Alex Richard Ford | Orthotist | 220 Westinghouse Blvd Ste 405, Charlotte, NC 28273-4260 | 2013-01-15 |
| 1992331730 | Andrew Carl Maurer | Orthotist | 2219 E 7th St, Charlotte, NC 28204-3339 | 2020-03-12 |
| 1366911828 | Colleen Cassidy Kerger | Orthotist | 2219 E 7th St, Charlotte, NC 28204-3339 | 2018-11-14 |
| 1710473251 | Mark Gingrich | Orthotist | 2219 E 7th St, Charlotte, NC 28204-3339 | 2018-07-09 |
| Find all providers in CHARLOTTE | ||||
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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.