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

Jessica Wallace

Individual provider Physical Therapist · NPI 1760206460

Jessica Wallace is a Physical Therapist in Private Practice in LA Plata, Maryland. Qualified in 2024, 2 years ago. Practices with La Plata Physical Therapy, a 4-clinician group and accepts Medicare assignment.

Years since qualifying
2
In the registry since
2024

Practice location Address checks out

101 Centennial St Ste C
LA Plata, MD 20646-5976
Phone: (301) 392-3700
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1760206460
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 11, 2024
Last updated in NPPESNovember 11, 2024
Certification dateNovember 11, 2024
Mailing address1911 S 21st St, Rogers, AR 72758-6101

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice La Plata Physical Therapy — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in LA Plata