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

Kelly Park

Individual provider Physical Medicine & Rehabilitation Physician · NPI 1073486395

Kelly Park is a Physical Medicine & Rehabilitation Physician in Wallingford, Pennsylvania. Practices as a sole proprietor. Licensed in Pennsylvania.

Licensed in
PA
In the registry since
2025

Practice location Address checks out

115 S Providence Rd
Wallingford, PA 19086-6333
Phone: (610) 565-3232
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence PT023909 (PA)

Record details

NPI number1073486395
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 24, 2025
Last updated in NPPESNovember 19, 2025
Certification dateNovember 19, 2025
Mailing address826a Putnam Blvd, Wallingford, PA 19086-6704

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