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

Kelly Wallace, PT

Individual provider Physical Therapist · NPI 1760727283

Kelly Wallace, PT is a Physical Therapist in Southaven, Mississippi. Practices as a sole proprietor. Licensed in Mississippi.

Licensed in
MS
In the registry since
2012
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

7160 Tchulahoma Rd Ste 4
Southaven, MS 38671-9266
Phone: (662) 349-2733
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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 1734 (MS)

Record details

NPI number1760727283
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT
Sole proprietorYes
NPI enumeratedDecember 10, 2012
Last updated in NPPESDecember 10, 2012

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