Active NPI
Kaitlin Brooke Wallace, PT, DPT
- Physical Therapist
- Maryville, TN
National Provider Identifier
1194482620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11686
- Practice address
- 629 Smithview Dr
Maryville, TN 37803-6100 - Phone
- (865) 984-8484
- NPI assigned
- Nov 18, 2021
- Last updated
- Nov 18, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11686 | TN | Primary |
Addresses
Primary practice location
629 Smithview Dr
Maryville, TN 37803-6100
Mailing address
12516 Lovelace Rd
Knoxville, TN 37932-1703
Phone (865) 804-5796
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | securerecords.sanford.html |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of TN Medical Center Home Care Services, LLC | Past | Accepting new patients | |
| University of TN Medical Center Home Care Services, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba University of TN Medical Center Home Care Services - Home Health
- Home Health Agency
- Knoxville, TN
- NPI 1346460953
-
dba University of TN Medical Center Home Care Services - Hospice
- Community Based Hospice Care Agency
- Knoxville, TN
- NPI 1619197365
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637193600000",
"number": "1194482620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12516 LOVELACE RD",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379321703",
"telephone_number": "865-804-5796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 SMITHVIEW DR",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378036100",
"telephone_number": "865-984-8484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KAITLIN",
"middle_name": "BROOKE",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-18",
"last_updated": "2021-11-18",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "11686",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "securerecords.sanford.html",
"affiliation": "N",
"address_1": "629 Smithview Dr",
"city": "Maryville",
"state": "TN",
"country_code": "US",
"postal_code": "378036100",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Maryville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.