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

Jonathan Wallace, DPT

Individual provider Physical Therapist · NPI 1619696648

Jonathan Wallace, DPT is a Physical Therapist in Private Practice in Plantation, Florida. Qualified in 2022, 4 years ago. Practices with Donner Physical Therapy and Sports Rehab Inc, a 3-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2022
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

8040 Peters Rd Ste H107
Plantation, FL 33324-4029
Phone: (954) 835-5619
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1619696648
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorYes
NPI enumeratedAugust 23, 2022
Last updated in NPPESAugust 23, 2022
Certification dateAugust 23, 2022
Mailing address3828 Nw 107th Way, Sunrise, FL 33351-8108

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Donner Physical Therapy And Sports Rehab Inc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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