Active NPI
Kelsey B Wallin
- Physical Therapist
- San Antonio, TX
National Provider Identifier
1083965610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 8715 Village Dr Ste 120
San Antonio, TX 78217-5425 - Phone
- (210) 477-5151
- Fax
- (210) 477-5152
- NPI assigned
- Sep 22, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Physical Therapist | 225100000X | PT 60216897 | WA |
Addresses
Primary practice location
8715 Village Dr Ste 120
San Antonio, TX 78217-5425
Mailing address
12709 Toepperwein Rd Ste 101
Live Oak, TX 78233-3259
Phone (210) 477-5151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1209640 | Other | TX | PHYSICAL THERAPIST LISCENCE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 60216897 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490918400000",
"number": "1083965610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12709 TOEPPERWEIN RD STE 101",
"city": "LIVE OAK",
"state": "TX",
"postal_code": "782333259",
"telephone_number": "210-477-5151",
"fax_number": "210-477-5152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8715 VILLAGE DR STE 120",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782175425",
"telephone_number": "210-477-5151",
"fax_number": "210-477-5152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLIN",
"first_name": "KELSEY",
"middle_name": "B",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-22",
"last_updated": "2017-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT 60216897",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPIST LISCENCE NUMBER",
"identifier": "1209640",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.