Kimberly Wallace, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT019083 Issued in PA

Practice address

421 W School House LN Unit 2
Philadelphia, PA 19144-4557

Phone

(973) 477-1421

NPI assigned

Jan 30, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• At Home by Enhance Therapies LLC

  • Physical Therapist
  • Lakewood, NJ
  • NPI 1124603246

  PA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359504000000",
    "number": "1033457791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 W SCHOOL HOUSE LN UNIT 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191444557",
            "telephone_number": "973-477-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W SCHOOL HOUSE LN UNIT 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191444557",
            "telephone_number": "973-477-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KIMBERLY",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-30",
        "last_updated": "2013-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT019083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dashiya Wallace
• Dylan Elizabeth Wallace, FNP
• Emily Wallace, RDN
• Fiona Marcia Wallace, M.S.
• Kelly Wallace
• Kimberly Wallace, PT
• Kristen Ashley Wallace, D.O.
• Meghan Meghan Wallace
• Molly Elizabeth Wallace, MD
• Paul Wallace, M.D.

• Physical Therapist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.