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

Logan Wallace

Individual provider Physical Therapist · NPI 1720798325

Logan Wallace is a Physical Therapist in Private Practice in Fayetteville, Arkansas. Qualified in 2021, 5 years ago. Practices with Rise Physical Therapy Inc, a 34-clinician group and accepts Medicare assignment.

Years since qualifying
5
In the registry since
2022
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Practice location Address checks out

1188 N Salem Rd Ste 1
Fayetteville, AR 72704-8803
Phone: (479) 595-0474
Fax: (479) 239-5444
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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 number1720798325
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 5, 2022
Last updated in NPPESFebruary 2, 2026
Certification dateFebruary 2, 2026
Mailing address2668 E Citizens Dr Ste 5, Fayetteville, AR 72703-4796

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Rise Physical Therapy Inc — 34 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Fayetteville