Mr Edwin Rush Wallace Iii, MPT | |
24560 Southpoint Dr Ste 250, Aldie, VA 20105-3504 | |
(571) 370-3686 | |
(571) 370-3687 |
Full Name | Mr Edwin Rush Wallace Iii |
---|---|
Gender | Male |
Speciality | Physical Therapist |
Location | 24560 Southpoint Dr Ste 250, Aldie, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1790968154 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 2305005465 (Virginia) | Primary |
Provider Name | Jackson Clinics Limited Partnership |
---|---|
Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1639594831 PECOS PAC ID: 2860623295 Enrollment ID: O20140423000896 |
Mailing Address | Practice Location Address |
---|---|
Mr Edwin Rush Wallace Iii, MPT Po Box 1769, Middleburg, VA 20118-1769 Ph: (571) 370-3686 | Mr Edwin Rush Wallace Iii, MPT 24560 Southpoint Dr Ste 250, Aldie, VA 20105-3504 Ph: (571) 370-3686 |
Miss Anna Carrenina Wiesbauer, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 25062 Lind Court, Aldie, VA 20105 Phone: 571-481-0241 | |
Makkah Rehabilitation Pt Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 41375 Tarragon Leaf Dr, Aldie, VA 20105 Phone: 201-450-0569 | |
Renee Packer-lowe, RPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 25620 Wyndham Point Ct, Aldie, VA 20105 Phone: 703-489-6299 Fax: 703-935-8710 | |
Renee Packer Pediatric Physical Therapy Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 25620 Wyndham Point Ct, Aldie, VA 20105 Phone: 703-489-6629 Fax: 703-935-8710 | |
Core Active Physical Therapy, Pllc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 41180 Turkey Oak Dr, Aldie, VA 20105 Phone: 571-245-3666 | |
Amelia Indira Franklin, DPT, OCS Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 24585 Stone Carver Dr Ste 275, Aldie, VA 20105 Phone: 037-383-1616 Fax: 703-383-1166 | |
Angela Petretta, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 24585 Stone Carver Dr Ste 275, Aldie, VA 20105 Phone: 703-383-1616 Fax: 703-383-1166 |