Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Lynn Wallace, DPT

Individual provider Physical Therapist · NPI 1750268520

Kelly Lynn Wallace, DPT is a Physical Therapist in Private Practice in Los Angeles, California. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in California, Florida and Texas.

Years since qualifying
1
Licensed in
CA, FL, TX
In the registry since
2025
Specialties on file
3
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

6801 Park Ter Ste 200
Los Angeles, CA 90045-1546
Phone: (310) 665-7100
Fax: (310) 665-7101
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 310150 (CA)
Physical Therapist Taxonomy 225100000X · Licence PT43619 (FL)
Physical Therapist Taxonomy 225100000X · Licence 1407872 (TX)

Record details

NPI number1750268520
Entity typeIndividual (Type 1)
GenderFemale
Credentials DPT
Sole proprietorYes
NPI enumeratedAugust 21, 2025
Last updated in NPPESMay 26, 2026
Certification dateMay 26, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations4 on file with Medicare

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