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NPI Code Detail

MEDICARE: GODIZA WALLACE

MEDICARE: GODIZA WALLACE
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
1225100000XPhysical Therapist24366MD

General Provider Information

NPI Number : 1083556591
Entity Type Code : Individual
Provider Name (Legal Business Name) : GODIZA WALLACE
Provider Business Mailing Address
First Line : 5425 WISCONSIN AVE STE 600
Second Line :
City : CHEVY CHASE
State : MD
Zip : 20815-3588
Country : US
Telephone Number : 866-525-3175
Fax Number :
Provider Business Practice Location Address
First Line : 5425 WISCONSIN AVE STE 600
Second Line :
City : CHEVY CHASE
State : MD
Zip : 20815-3588
Country : US
Telephone Number : 866-525-3175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ GODIZA WALLACE ” Practice Location

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