KELLY LYNN WALLACE DPT
NPI 1750268520
Physical Therapist in Los Angeles, CA

Active since August 21, 2025Accepts Medicare Assignment
6801 PARK TER STE 200, LOS ANGELES, CA 90045(310) 665-7100(310) 665-7101 Get Directions Write a Review

NPPES record last updated: May 26, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kelly Lynn Wallace Dpt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY LYNN WALLACE DPT (NPI 1750268520) is an individual physical therapist in Los Angeles, California, licensed in California (310150) and active in the NPI registry since August 2025. She is a graduate of Other (2025).

NPPES Registry Identity

NPI1750268520
Entity TypeIndividualFemale
Primary Taxonomy225100000X
Provider Legal NameKELLY LYNN WALLACECredential: DPT
Location Address6801 PARK TER STE 200Los Angeles, CA 90045-1546
Mailing Address780 E Dorchester DrSaint Johns, FL 32259-6287
Fax(310) 665-7101
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateAugust 21, 2025
Last NPPES UpdateMay 26, 2026
NPPES CertifiedMay 26, 2026
✔ NPI 1750268520 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
Licenses✔ Licensed in CA · 310150✔ Licensed in FL · PT43619✔ Licensed in TX · 1407872
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 perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
6801 PARK TER STE 200, Los Angeles, CA 90045

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Lynn Wallace Dpt is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3476057043
PECOS Enrollment IDI20260702002851

Medicare Billing Reassignment

Medicare enrollment records show Kelly Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Physical Therapy
6801 PARK TER STE 200
Los Angeles, CA 90045
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Select Cs Physical Therapy PC
  • 217 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90045 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapy Assistant
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Physical Therapy Assistant
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Physical Therapist
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Occupational Therapist
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Physical Therapist
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Physical Therapist
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Physical Therapist
6801 PARK TER STE 200
LOS ANGELES, CA 90045
Physical Therapist
6801 PARK TER STE 200
LOS ANGELES, CA 90045

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Wallace's NPI number?

The NPI number for Kelly Wallace is 1750268520. It was assigned to this individual provider in the NPPES registry on August 21, 2025.

Where is Kelly Wallace located?

Kelly Wallace practices at 6801 Park Ter Ste 200, Los Angeles, CA 90045. The listed phone number is (310) 665-7100.

What is Kelly Wallace's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Is Kelly Wallace enrolled in Medicare?

Yes. Kelly Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Kelly Wallace's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Wallace reassigns Medicare benefits to Select Cs Physical Therapy, P.C. (Los Angeles, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kelly Wallace was last updated on May 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.