Individual provider · Type 1 NPI

Mario James Wallace, PT, DPT

Orthopedic Physical Therapist · New York, NY

NPI number 1043064009 Active

Practice location

4246 Broadway
New York, NY 10033-3708

Call (646) 790-7463 Map

Mailing address

2649 Strang Blvd Ste 304
Yorktown Heights, NY 10598-2938

Other practice locations

  • 235 W 75th St, New York, NY 10023-0328 · (646) 518-5559

Specialties and licenses

TaxonomyCodeLicense
Orthopedic Physical Therapist Primary 2251X0800X052204 (NY)

Orthopedic Physical Therapist: A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based prac…

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About NPI 1043064009

Mario James Wallace, PT, DPT's National Provider Identifier is 1043064009, issued on Apr 16, 2024. The primary taxonomy on file is Orthopedic Physical Therapist (2251X0800X), and the practice location is in New York, NY. The record was last updated on Oct 14, 2026.