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

Mr. Robert Jason Wallace, ATC

Individual provider Athletic Trainer · NPI 1972325603

Mr. Robert Jason Wallace, ATC is an Athletic Trainer in Detroit, Michigan. Licensed in Michigan. Registered with an NPI since 2024.

Licensed in
MI
In the registry since
2024
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

261 Mack Ave
Detroit, MI 48201-2417
Phone: (313) 966-7246
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 2601001545 (MI)

Record details

NPI number1972325603
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC
Sole proprietorNo
NPI enumeratedOctober 24, 2024
Last updated in NPPESOctober 24, 2024
Certification dateOctober 24, 2024

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