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

Shane Bradley Wall, PT

Individual provider Physical Therapist · NPI 1992287619

Shane Bradley Wall, PT is a Physical Therapist in Private Practice in De Leon, Texas. Qualified in 1997, 29 years ago. Accepts Medicare assignment. Licensed in Texas.

Years since qualifying
29
Licensed in
TX
In the registry since
2018
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

400 S Houston St
De Leon, TX 76444-1928
Phone: (254) 893-2015
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 1125359 (TX)

Record details

NPI number1992287619
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedAugust 29, 2018
Last updated in NPPESSeptember 4, 2020
Certification dateSeptember 4, 2020
Mailing address400 S Houston St., De Leon, TX 76444

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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