MEDICARE: DR. JOHN R. WALLIS D.MIN.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	MT1251	FL

General Provider Information

NPI Number	:	1023161197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R. WALLIS D.MIN.

Provider Business Mailing Address
First Line	:	1417 SE 4TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2319
Country	:	US
Telephone Number	:	954-463-2273
Fax Number	:	954-779-1643

Provider Business Practice Location Address
First Line	:	1417 SE 4TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2319
Country	:	US
Telephone Number	:	954-463-2273
Fax Number	:	954-779-1643

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

Similar Medicare Providers

1659491199 — DR. JANET F COHEN PH,D.
Practice Location Address:

1417 SE 4TH ST
FORT LAUDERDALE, FL
33301-2319

Practice Phone: 954-463-2273
Practice Fax: 954-779-1643

1164544078 — CANDACE SHERBURNE FIRTH PH.D.
Practice Location Address:

1417 SE 4TH ST
FORT LAUDERDALE, FL
33301-2319

Practice Phone: 561-832-7788
Practice Fax: 954-779-1643

1184032955 — WAL-MART STORES TEXAS LLC
Practice Location Address:

2245 JACKSBORO HWY
FT WORTH, TX
76114-2319

Practice Phone: 817-569-6241
Practice Fax: 817-569-6242

1356759252 — MARLENE STINE COTA
Practice Location Address:

2319 DOVER AVE
FT MYERS, FL
33907-4218

Practice Phone: 239-931-0550
Practice Fax:

1215503503 — MEGAN MARIE HUNZIKER BCBA
Practice Location Address:

1244 NE 16TH AVE
FORT LAUDERDALE, FL
33304-2319

Practice Phone: 732-890-2928
Practice Fax:

1043299456 — STEVEN GARY KESSLER MD
Practice Location Address:

1212 E BROWARD BLVD STE 204
FT LAUDERDALE, FL
33301-2121

Practice Phone: 954-496-4591
Practice Fax:

Directions to “ DR. JOHN R. WALLIS D.MIN.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.