Kaitlyn D Wallace, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P15088 Issued in NC

Practice address

3803B Computer Dr Ste 200
Raleigh, NC 27609-6503

Phone

(919) 791-3582

Fax

(919) 791-3583

NPI assigned

Sep 10, 2014

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)

Not enrolled

State licenses

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.

• Raleigh Therapy Services, Inc

  • Speech-Language Pathologist
  • Raleigh, NC
  • NPI 1790808350

  Physical Therapist

  NPD (past)
• Triangle Dysphagia and Feeding LLC

  • Speech-Language Pathologist
  • Raleigh, NC
  • NPI 1104373653
  NPD (past)
• Jones Therapy Services LLC

  • Pediatric Rehabilitation Medicine Physician
  • Murfreesboro, TN
  • NPI 1811213556

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1124429048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803B COMPUTER DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096503",
            "telephone_number": "919-791-3582",
            "fax_number": "919-791-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3803B COMPUTER DR STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096503",
            "telephone_number": "919-791-3582",
            "fax_number": "919-791-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KAITLYN",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-10",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P15088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Rose Wallace
• Courtney Brooke Wallace, PT
• Cynthia Moreno Wallace, NP
• Jocelyn Jones Wallace, LCAS-A, LPC-A
• Julie Anne Wallace, LCMHCA
• Kathryn Paige Wallace, CCC-SLP
• Nicole Janeen Wallace, LCMHC
• Sarah Wallace
• Senetra Wallace, LCSW
• David Wallach

• All providers in Raleigh, NC
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; 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.