MR. ROBERT JASON WALLACE ATC
NPI 1972325603
Specialist/Technologist - Athletic Trainer in Detroit, MI

Q: What is Robert Wallace's NPI number?

The NPI number for Robert Wallace is 1972325603. It was assigned to this individual provider in the NPPES registry on October 24, 2024.

Q: What is Robert Wallace's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, specializing in Athletic Trainer, with taxonomy code 2255A2300X.

Q: When was this NPI record last updated?

The NPPES record for Robert Wallace was last updated on October 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.

Active since October 24, 2024

261 MACK AVE, DETROIT, MI 48201(313) 966-7246 Get Directions Write a Review

NPPES record last updated: October 24, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Mr. Robert Jason Wallace Atc NPPES

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

MR. ROBERT JASON WALLACE ATC (NPI 1972325603) is an individual athletic trainer provider in Detroit, Michigan, licensed in Michigan (2601001545) and active in the NPI registry since October 2024.

NPPES Registry Identity

NPI1972325603

Entity TypeIndividualMale

Primary Taxonomy2255A2300X

Provider Legal NameMR. ROBERT JASON WALLACECredential: ATC

Location Address261 MACK AVEDetroit, MI 48201-2417

Mailing Address8946 San Marco BlvdSterling Heights, MI 48313-4866 · (586) 488-6467

Phone(313) 966-7246

Sole ProprietorNo

Enumeration DateOctober 24, 2024

NPPES CertifiedOctober 24, 2024

✔ NPI 1972325603 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialist/Technologist · Athletic TrainerRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code2255A2300X

License✔ Licensed in MI · 2601001545

Definition

Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor's degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration.

261 MACK AVE, Detroit, MI 48201

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