Mr Randall Allen Wallace, PT is a
Physical Therapist - Ergonomics based in Oaklahoma City, Oklahoma. Mr Randall Allen Wallace is licensed to practice in Oklahoma (license number PT2855) and his current practice location is
409 E. California Ave., Oaklahoma City, Oklahoma. He can be reached at his office (for appointments etc.) via phone at
(405) 879-6766.
NPI number for Mr Randall Allen Wallace is 1497820252 and his current mailing address is 18305 English Oak Ln, Edmond, Oklahoma. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1497820252.
Healthcare Provider's Profile
| Full Name | Mr Randall Allen Wallace |
|---|
| Gender | Male |
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| Speciality | Physical Therapist - Ergonomics |
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| Location | 409 E. California Ave., Oaklahoma City, Oklahoma |
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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: 1497820252
- Provider Enumeration Date: 11/21/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Mr Randall Allen Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1497820252 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225100000X | Physical Therapist | PT2855 (Oklahoma) | Primary |
| 2251E1200X | Physical Therapist - Ergonomics | PT2855 (Oklahoma) | 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 Randall Allen 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 Randall Allen Wallace, PT
18305 English Oak Ln,
Edmond, OK 73003-4051
Ph: (405) 216-8731 | Mr Randall Allen Wallace, PT
409 E. California Ave.,
Oaklahoma City, OK 73104
Ph: (405) 879-6766 |
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