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

Gary Robert Wallace, PTA

Individual provider Physical Therapy Assistant · NPI 1003009184

Gary Robert Wallace, PTA is a Physical Therapy Assistant in Jackson, Mississippi. Licensed in Louisiana. Registered with an NPI since 2007.

Licensed in
LA
In the registry since
2007
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Practice location Address checks out

13 Northtown Dr Trinity Rehab Ste 110
Jackson, MS 39211
Phone: (601) 206-9195
Fax: (601) 957-8391
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence A2636 (LA)

Record details

NPI number1003009184
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedAugust 22, 2007
Last updated in NPPESAugust 22, 2007
Mailing address13 Northtown Dr, Suite 110 Trinity Rehab, Jackson, MS 39211

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