Mr Lawrence Wallace, MD, PT is a
Physical Therapist physician based in North Myrtle Beach, South Carolina. Mr Lawrence Wallace is licensed to practice in South Carolina (license number 11194) and his current practice location is 1021 2nd Ave N Ste 6, North Myrtle Beach, South Carolina. He can be reached at his office (for appointments etc.) via phone at
(843) 286-5168.
NPI number for Mr Lawrence Wallace is 1679567192 and his current mailing address is 1021 2nd Ave N Ste 6, North Myrtle Beach, South Carolina. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1679567192.
Physician's Profile
| Full Name | Mr Lawrence Wallace |
|---|
| Gender | Male |
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| Speciality | Physical Therapist |
|---|
| Location | 1021 2nd Ave N Ste 6, North Myrtle Beach, South Carolina |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1679567192
- Provider Enumeration Date: 09/12/2005
- Last Update Date: 01/26/2026
Medical Identifiers
Medical identifiers for Mr Lawrence Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1679567192 | NPI | - | NPPES |
| 010114446 | Medicaid | VA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207X00000X | Orthopaedic Surgery | MD439714 (Pennsylvania) | Secondary |
| 225100000X | Physical Therapist | P2177 (North Carolina) | Secondary |
| 207X00000X | Orthopaedic Surgery | 0101234728 (Virginia) | Secondary |
| 225100000X | Physical Therapist | 11194 (South Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Lawrence Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Lawrence Wallace, MD, PT
1021 2nd Ave N Ste 6,
North Myrtle Beach, SC 29582-3200
Ph: (843) 286-5168 | Mr Lawrence Wallace, MD, PT
1021 2nd Ave N Ste 6,
North Myrtle Beach, SC 29582-3200
Ph: (843) 286-5168 |
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