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

Mr. John Robert Wallace, MSPT

Individual provider Physical Therapist · NPI 1275663916

Mr. John Robert Wallace, MSPT is a Physical Therapist in Private Practice in Nags Head, North Carolina. Qualified in 1992, 34 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
34
Licensed in
NC
In the registry since
2007

Practice location Address checks out

103 W Woodhill Dr Ste A
Nags Head, NC 27959
Phone: (252) 441-8580
Fax: (252) 441-9551
Show map & directions

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

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 5301 (NC)

Record details

NPI number1275663916
Entity typeIndividual (Type 1)
GenderMale
Credentials MSPT
Sole proprietorYes
NPI enumeratedMarch 6, 2007
Last updated in NPPESMarch 10, 2020
Certification dateMarch 10, 2020
Mailing addressPo Box 716, Kill Devil Hills, NC 27948

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 1992 (34 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Nags Head