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

Theresa A Wallace, PA-C, ATC

Individual provider Athletic Trainer · NPI 1437404548

Theresa A Wallace, PA-C, ATC is a Physician Assistant in Daytona Beach, Florida. Qualified in 2019, 7 years ago. Practices with Orthopaedic Clinic of Daytona Beach PA, a 48-clinician group, works from 7 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
7
Licensed in
FL
In the registry since
2012
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone: (386) 255-4596
Fax: (386) 258-3561
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (6)

  • 1075 Mason Ave, Daytona Beach, FL 32117-4611 — (386) 255-4596
  • 1890 Lpga Blvd Ste 240, Daytona Beach, FL 32117-7131 — (386) 255-4596
  • 1325 San Marco Blvd, Jacksonville, FL 32207-8568 — (904) 858-7045
  • 17 Old Kings Rd N Ste K, Palm Coast, FL 32137-8283 — (386) 255-4596
  • 1165 Dunlawton Ave Ste 102, Port Orange, FL 32127-2924 — (386) 255-4596
  • 1175 Dunlawton Ave Ste 1, Port Orange, FL 32127-4741 — (386) 255-4596

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9113017 (FL)
Athletic Trainer Taxonomy 2255A2300X · Licence AL2836 (FL)

Record details

NPI number1437404548
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C , ATC
Sole proprietorNo
NPI enumeratedJuly 16, 2012
Last updated in NPPESNovember 21, 2024
Certification dateNovember 21, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Orthopaedic Clinic Of Daytona Beach Pa — 48 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Daytona Beach