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

Mr. Mario James Wallace, PT, DPT

Individual provider Orthopedic Physical Therapist · NPI 1043064009

Mr. Mario James Wallace, PT, DPT is a Physical Therapist in Private Practice in New York, New York. Qualified in 2024, 2 years ago. Practices with Spear Physical and Occupational Therapy, LLC, a 577-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
2
Licensed in
NY
In the registry since
2024
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

235 W 75th St
New York, NY 10023-0328
Phone: (646) 518-5559
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopedic Physical Therapist (primary) Taxonomy 2251X0800X · Licence 052204 (NY)

Record details

NPI number1043064009
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT
Sole proprietorYes
NPI enumeratedApril 16, 2024
Last updated in NPPESApril 16, 2024
Certification dateApril 16, 2024

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 Spear Physical And Occupational Therapy, Llc — 577 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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