Wallace, Jim F
Wallace, Jim F is an individual health care provider with primary practice located at 404 Ne Penn Ave , Bend OR 97701-4264. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Wallace, Jim F can be contacted via phone (541) 318-7041.Contact Information
Primary practice address
404 Ne Penn Ave
Bend OR 97701-4264
Phone: (541) 318-7041
Fax: (541) 388-3711
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic | 2251X0800X | 2948 | Oregon |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 02948 | Oregon |
Profile Details
| NPI number | 1194928481 |
|---|---|
| LBN Legal business name | Wallace, Jim F |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2007 |
| Last updated | Dec 29th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194928481 | NPPES |
| Oregon | MEDICAID | 500694596 |
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