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General NPI Number Information
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NPI Number | 1720946551
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Entity Type | Individual
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Provider Name | ALICIA JACQUELINE WALLACE
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Gender | Female
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 960
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4315
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Country | US
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Telephone | 301-986-4745
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 4TH ST NE APT 1208
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City | WASHINGTON
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State | DC
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Zip | 20002-6899
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Country | US
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Telephone | 908-510-1348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30742
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License Number State | MD
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