Mario James Wallace, PT, DPT
NPI 1043064009ActiveIndividual· Physical Therapist, Orthopedic· New York, NY
Physical Therapist, Orthopedic (PT, DPT) with Spear Physical and Occupational Therapy, LLC, practicing in New York, New York. Medicare paid $67,763 for services to 108 patients in 2024.
Overview
| NPI | 1043064009 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT, DPT |
| Sole proprietor | Yes |
| NPI issued | Apr 16, 2024 |
| Last updated in NPPES | Oct 14, 2026 |
| Certified by provider | Oct 14, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist, Orthopedic Primary | 2251X0800X | 052204 | NY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (NY) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 108 |
|---|---|
| Services billed | 2,790 across 7 procedure codes |
| Paid by Medicare | $67,763 |
Education and affiliations
| Graduation year | 2024 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Spear Physical and Occupational Therapy, LLCNew York, NY · 593 clinicians
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