Kristin Nicole Kellim, M.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40993 Issued in CA

Practice address

500 E Colorado St Ste 120
Glendale, CA 91205-1651

Phone

(213) 212-4308

Fax

(213) 261-0973

NPI assigned

Apr 15, 2008

Last updated

May 14, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kristin Nicole Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vargo Physical Therapy, Inc.

  • Physical Therapist
  • Northridge, CA
  • NPI 1386768539
  NPD (past)
• JKH Management, LLC

  dba Apex Physical Therapy

  • Physical Therapy Clinic/Center
  • Wood River, IL
  • NPI 1467698068

  Physical Therapist

  NPD (past)
• Rehab Management Group, LLC

  dba ApexNetwork Physical Therapy

  • Physical Therapy Clinic/Center
  • O'Fallon, IL
  • NPI 1801189642

  Physical Therapist

  NPD (past)
• Therapy Solutions, LLC

  • Physical Therapist
  • Perryville, MO
  • NPI 1790894962
  NPD (past)

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1306010913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 BRISTOL ST STE 600",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261810",
            "telephone_number": "213-212-4308",
            "fax_number": "213-261-0973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E COLORADO ST STE 120",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051651",
            "telephone_number": "213-212-4308",
            "fax_number": "213-261-0973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLIM",
        "first_name": "KRISTIN",
        "middle_name": "NICOLE",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "2008010372",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.017045",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "40993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "WALLACE",
            "middle_name": "NICOLE",
            "credential": "PT MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aram Keledjian
• Natalie Keleshyan
• Sogomon Keleshyan
• Makenzie Kelley
• Trisha Kelley, MD
• Rophine Moriah Kenfack, DAOM
• Kenneth Road Pharmacy Inc
• Kent Candelora, PHD, a Psychological Corporation
• Kent W Small, MD a Medical Corporation
• Julie Dawn Kenworth-Caragio, LMFT

• Physical Therapist in Glendale, CA
• Providers in Glendale, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; 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.