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

Collin William Wallace, DPT

Individual provider Physical Therapist · NPI 1568830719

Collin William Wallace, DPT is a Physical Therapist in Private Practice in Riverview, Florida. Qualified in 2015, 11 years ago. Practices with Ohi West Medical Group LLC, a 200-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
11
Licensed in
FL
In the registry since
2015
Specialties on file
2
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

11375 Big Bend Rd
Riverview, FL 33579-7183
Phone: (813) 805-8167
Fax: (844) 214-1382
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2349 Sunset Point Rd Ste 400, Clearwater, FL 33765-1439 — (970) 371-8965

Specialties & licences

Orthopedic Physical Therapist (primary) Taxonomy 2251X0800X · Licence PT30787 (FL)
Physical Therapist Taxonomy 225100000X · Licence PT30787 (FL)

Record details

NPI number1568830719
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorYes
NPI enumeratedSeptember 4, 2015
Last updated in NPPESMarch 2, 2026
Certification dateMarch 2, 2026
Mailing address11375 Big Bend Rd, Riverview, FL 33579-7183

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Ohi West Medical Group Llc — 200 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Riverview