Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Gary Robert Wallace, PTA

Individual provider Physical Therapy Assistant · NPI 1003009184

Gary Robert Wallace, PTA is a Physical Therapy Assistant in Jackson, Mississippi. Licensed in Louisiana. Registered with an NPI since 2007.

Licensed in
LA
In the registry since
2007
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

13 Northtown Dr Trinity Rehab Ste 110
Jackson, MS 39211
Phone: (601) 206-9195
Fax: (601) 957-8391
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence A2636 (LA)

Record details

NPI number1003009184
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedAugust 22, 2007
Last updated in NPPESAugust 22, 2007

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