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

Nicole Marie Wallace, PT

Individual provider Specialist · NPI 1609089028

Nicole Marie Wallace, PT is a Physical Therapist in Private Practice in Virginia Beach, Virginia. Qualified in 1998, 28 years ago. Practices with Legacy Healthcare Services Inc, a 3,624-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
28
Licensed in
VA
In the registry since
2007
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

913 First Colonial Rd Ste 204
Virginia Beach, VA 23454-3198
Phone: (757) 550-0725
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X
Children's Hospital Taxonomy 282NC2000X · Licence 2305203070 (VA)

Record details

NPI number1609089028
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT
Sole proprietorYes
NPI enumeratedMay 8, 2007
Last updated in NPPESMarch 18, 2019

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Group practice Legacy Healthcare Services Inc — 3624 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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