Kimberly Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT007970L Issued in PA

Practice address

420 Bainbridge St
453 Lower Indian Head Road
Philadelphia, PA 19147-1568

Phone

(215) 629-3837

Fax

(215) 629-5531

NPI assigned

Jul 18, 2005

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Orthopedic and Sports Physical Therapy Services, Inc.

  • Physical Therapist
  • Philadelphia, PA
  • NPI 1588661235
  NPD (past)

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1114926698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BAINBRIDGE ST",
            "address_2": "453 LOWER INDIAN HEAD ROAD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471568",
            "telephone_number": "215-629-3837",
            "fax_number": "215-629-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 BAINBRIDGE ST",
            "address_2": "453 LOWER INDIAN HEAD ROAD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471568",
            "telephone_number": "215-629-3837",
            "fax_number": "215-629-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KIMBERLY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT007970L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Elizabeth Wallace, FNP
• Emily Wallace, RDN
• Fiona Marcia Wallace, M.S.
• Kelly Wallace
• Kimberly Wallace, MPT
• Kristen Ashley Wallace, D.O.
• Meghan Meghan Wallace
• Molly Elizabeth Wallace, MD
• Paul Wallace, M.D.
• Rasheada Lynn Wallace, (CD,PCD)

• 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 Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.