DREW MICHAEL WALLACE (NPI# 1669878625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669878625 |
| Entity Type | Individual |
| Full Name | DREW MICHAEL WALLACE |
| Credential | ATC |
| Practice Address |
17823 Poplar Grove Rd Poplar Grove IL 61065-9014 |
| Mailing Address |
5061 Linden Rd #5303 Rockford IL 61109-5834 |
| Practice Telephone | 8157653311 |
| Mailing Telephone | 8158785391 |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2014-11-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
200014924 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295899698 | Drew D Wallace | Psychologist | 6893 Sw 18th St, Suite F-101, Boca Raton, FL 33433-7044 | 2006-12-20 |
| 1205921608 | Drew George Wallace | Chiropractor | 1801 West Avenue N, San Angelo, TX 76904 | 2006-10-03 |
| 1437114139 | Drew A Wallace | Physical Therapist | 1600 Bethlehem Pike, Flourtown, PA 19031-2026 | 2006-04-18 |
| Street Address |
17823 POPLAR GROVE RD |
| City | POPLAR GROVE |
| State | IL |
| Zip Code | 61065-9014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568000768 | Jessica Ballard | Specialist/Technologist | 17823 Poplar Grove Rd, Poplar Grove, IL 61065-9014 | 2019-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992352819 | Amber Suarez-christensen | Occupational Therapist | 4950 Il-173, Poplar Grove, IL 61065 | 2019-08-26 |
| 1588227300 | Kimberly Jozwiak | Counselor | 4950 Rte. 173, Poplar Grove, IL 61065 | 2019-04-17 |
| 1902252075 | Pioneer Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 310 Constitution Drive Sowth West, Poplar Grove, IL 61065 | 2016-05-09 |
| 1568738821 | Ashley Lynn Moritz | Speech-Language Pathologist | 4950 Route 173, Poplar Grove, IL 61065 | 2012-03-30 |
| 1326202441 | Felker Pharmacy Inc | Pharmacy | 13521 Illinois Rt 76, Poplar Grove, IL 61065 | 2008-07-17 |
| 1295744183 | William M Bitsas | Family Medicine | 406 Maple Leaf Ln, Poplar Grove, IL 61065 | 2006-08-07 |
| 1790718104 | Troy Michael Doetch | Family Medicine | 1200 Candlewick Dr Nw, Poplar Grove, IL 61065 | 2006-07-09 |
| 1548667371 | Gemma Fletcher | Physical Therapist | 4950 Route 173, Poplar Grove, IL 61065 | 2014-11-21 |
| 1700207768 | Kathy Blackmer | Counselor | 13508 Julie Dr, Poplar Grove, IL 61065 | 2013-12-18 |
| 1598883670 | Jeffry Stephen Clow | Speech-Language Pathologist | 492 Prairie Knoll Dr, Poplar Grove, IL 61065-7817 | 2007-03-27 |
| Find all providers in zip 61065 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154815322 | Joseph M Rocuskie | Specialist/Technologist | 105 Galahad Ct Se, Poplar Grove, IL 61065-9094 | 2018-06-20 |
| 1568000768 | Jessica Ballard | Specialist/Technologist | 17823 Poplar Grove Rd, Poplar Grove, IL 61065-9014 | 2019-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771076 | Stacey Weathers-cannon | Specialist/Technologist | 650 Ingraham Ave, Calumet City, IL 60409-4236 | 2020-08-17 |
| 1104438621 | Abril Malagon | Specialist/Technologist | 1 S Greenwood Ave, Palatine, IL 60074-6328 | 2020-08-17 |
| 1265050678 | Megan Elsbree | Specialist/Technologist | 11819 Deacon Dr, Rockton, IL 61072-9411 | 2020-07-13 |
| 1013534437 | Nicole Rose Mondelli | Specialist/Technologist | 958 Tallgrass Dr, Bartlett, IL 60103-5071 | 2020-07-01 |
| 1740806413 | Megan Herter | Specialist/Technologist | 1513 Old Ivy Dr, Springfield, IL 62711-8156 | 2020-06-18 |
| 1164047239 | Madison Stagman | Specialist/Technologist | 280 Douglas Ave Apt 4, Mascoutah, IL 62258-2963 | 2020-06-14 |
| 1588286272 | Sarah Wegrzyn | Specialist/Technologist | 3040 S Wabash Ave, Chicago, IL 60616-3474 | 2020-05-15 |
| 1336761386 | Christine Louise Shebelski | Specialist/Technologist | 15203 Pulaski Rd, Midlothian, IL 60445-3755 | 2020-05-13 |
| 1386266633 | Kathryn Riordan | Specialist/Technologist | 221 Triton Ln, Naperville, IL 60540-7926 | 2020-05-09 |
| 1487276747 | Vianey Hernandez-ramirez | Specialist/Technologist | 4115 Howard St, Skokie, IL 60076-3749 | 2020-05-09 |
| Find all providers with the same taxonomy | ||||
| City | POPLAR GROVE |
| Zip Code | 61065 |
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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.