Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Andre Lamar Wallace

Individual provider Massage Therapist · NPI 1578178844

Andre Lamar Wallace is a Massage Therapist in Philadelphia, Pennsylvania. Practices as a sole proprietor. Licensed in Pennsylvania.

Licensed in
PA
In the registry since
2020
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Practice location Address checks out

435 W Roosevelt Blvd Apt 2
Philadelphia, PA 19120-4148
Phone: (215) 435-5560
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Massage Therapist (primary) Taxonomy 225700000X · Licence MSG007581 (PA)

Record details

NPI number1578178844
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 13, 2020
Last updated in NPPESSeptember 13, 2020
Certification dateSeptember 4, 2020

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