Kelly Wallace is a Physical Therapist in Choctaw, Oklahoma. Kelly Wallace practices all healthcare services and medical treatments related to Physical Therapist. The NPI Number for Kelly Wallace is 1184696023. The last update date is 2015-04-27.
Kelly Wallace's current location address is 13390 Ne 23rd St, Choctaw, Oklahoma. You can contact this provider via phone number 4057695555 and fax number 4057695558. The mailing address for Kelly Wallace is 13390 Ne 23rd St, Choctaw, Oklahoma. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kelly Wallace |
|---|---|
| Address | 13390 Ne 23rd St, Choctaw, Oklahoma |
| Phone Number | 4057695555 |
| Fax Number | 4057695558 |
| Sole Proprietor | N |
| Credentials | RPT |
NPI Number Detail
| NPI Number | 1184696023 |
|---|---|
| Provider Enumeration Date | 2006-02-05 |
| Last Updated Date | 2015-04-27 |
Provider Mailing Address Detail
| Address | 13390 Ne 23rd St |
|---|---|
| City | Choctaw |
| State | Oklahoma (OK) |
| Post Code | 730208622 |
| Phone Number | 4057695555 |
| Fax Number | 4057695558 |
Provider's Primary Taxonomy Detail
| Speciality | Physical Therapist |
|---|---|
| Taxonomy | 225100000X |
| Licence No | PT2460 |
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Definition: Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and per |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 200552760A | OK | -- |
Post Comment/ Review Below
What is the Kelly Wallace's unique identification number?
The Kelly Wallace has been assigned the NPI (National Provider Identifier) Number 1184696023 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you please provide the complete physical location address of Kelly Wallace?
The Kelly Wallace is physically situated at 13390 Ne 23Rd St, in the city of Choctaw, state of OK, with the postal code 730208622.
What is Kelly Wallace's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Kelly Wallace is Physical Therapist, and the taxonomy code that classifies this field of practice is 225100000X.
On what date did Kelly Wallace receive its 1184696023 assignment from the Centers for Medicare & Medicaid Services?
The Kelly Wallace was assigned its 1184696023 on 2006-02-05, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date was the information pertaining to Kelly Wallace, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Kelly Wallace, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2015-04-27.
NPI Number: 1134135452
Address: 1145 Sturgis Road, Twentynine Palms, CA