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Individual

MR. JOHN DOUGLASS WALLOP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17006
MD
2251P0200X
Pediatric Physical Therapist
17006
MD
2251S0007X
Sports Physical Therapist
17006
MD
2251X0800X
Orthopedic Physical Therapist
17006
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
227912
MAMSI PROVIDER NUMBER
MD
01
2621453
AETNA HMO NUMBER
MD
01
53056502
BC REGION RENDERING #
MD
01
7947168
AETNA NON-HMO NUMBER
MD
01
KN59
BLUE CROSS LOCAL #
MD
01
W0290002
BC FEDERAL, BLUE CHOICE #
MD
Enumeration date
08/25/2005
Last updated
05/09/2012
Update your record

If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.

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