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NICOLE MARIE WALLACE PT
NPI 1609089028
Specialist in Virginia Beach, VA

Active since May 08, 2007Accepts Medicare Assignment
913 FIRST COLONIAL RD STE 204, VIRGINIA BEACH, VA 23454(757) 550-0725 Get Directions Write a Review

NPPES record last updated: March 18, 2019. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Nicole Marie Wallace Pt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE MARIE WALLACE PT (NPI 1609089028) is an individual specialist in Virginia Beach, Virginia and active in the NPI registry since May 2007. She is a graduate of Other (1998).

NPPES Registry Identity

NPI1609089028
Entity TypeIndividualFemale
Primary Taxonomy174400000X
Provider Legal NameNICOLE MARIE WALLACECredential: PT
Location Address913 FIRST COLONIAL RD STE 204Virginia Beach, VA 23454-3198
Mailing Address913 First Colonial Rd Ste 204Virginia Beach, VA 23454-3198 · (757) 550-0725
Phone(757) 550-0725
Sole ProprietorYes
Medical School CMSOtherGraduated 1998
Enumeration DateMay 8, 2007
Last NPPES UpdateMarch 18, 2019
✔ NPI 1609089028 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Also ListedGeneral Acute Care Hospital · ChildrenTaxonomy 282NC2000X · License 2305203070 (VA)
913 FIRST COLONIAL RD STE 204, Virginia Beach, VA 23454
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicole Marie Wallace Pt is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7012135304
PECOS Enrollment IDI20140828000778

Medicare Billing Reassignment

Medicare enrollment records show Nicole Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Legacy Healthcare Services, Inc
155 mi
Physical Therapist
5901 MACARTHUR BLVD NW
Washington, DC 20016
  • Reassigned Medicare billing, District of Columbia and Virginia enrollments
  • Also billed through NPI 1740820828 (Virginia)
  • 69 clinicians in this Medicare group
NPI 1255750030 (919) 424-5080

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LISA TERRY
Developmental Therapist
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 550-0725
HELPING HANDS THERAPY SERVICES
Physical Therapist
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 550-0725
HELPING HANDS THERAPY SERVICES
Speech-Language Pathologist
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 550-0725
REMEDY HOME HEALTH CARE LLC
Home Health
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 960-5920
VICTORIA HULSING PT, DPT
Physical Therapist
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 353-1024
HELPING HANDS THERAPY SERVICES
Occupational Therapist
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 550-0725
LAURA BRIGHTON, LCSW
Social Worker (Clinical)
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 622-7017
THE LANGUAGE LITERACY DOCTOR
Speech-Language Pathologist
913 FIRST COLONIAL RD STE 204
VIRGINIA BEACH, VA 23454
Virginia Beach City (757) 632-0704

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Wallace's NPI number?

The NPI number for Nicole Wallace is 1609089028. It was assigned to this individual provider in the NPPES registry on May 8, 2007.

Where is Nicole Wallace located?

Nicole Wallace practices at 913 First Colonial Rd Ste 204, Virginia Beach, VA 23454. The listed phone number is (757) 550-0725.

What is Nicole Wallace's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Nicole Wallace enrolled in Medicare?

Yes. Nicole Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Nicole Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicole Wallace reassigns Medicare benefits to Legacy Healthcare Services, Inc (Washington, DC). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicole Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nicole Wallace was last updated on March 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.