KELLY LYNN WALLACE DPT
NPI 1750268520
Physical Therapist in Los Angeles, CA
NPI Status: Active since August 21, 2025
Contact Information
6801 PARK TER STE 200
LOS ANGELES, CA
ZIP 90045
Phone: (310) 665-7100
Fax: (310) 665-7101
Some details in this NPI profile have been updated in the NPI registry within the last 30 days.
- Individual
- Female
- Years of Experience 1
- Physical Therapist
- May Accept Medicare Approved Payment
About KELLY WALLACE
This page provides the complete NPI Profile along with additional information for Kelly Wallace, a provider established in Los Angeles, California with a medical specialization in Physical Therapist and more than one year of experience. The healthcare provider is registered in the NPI registry with number 1750268520 assigned on August 2025. The practitioner's primary taxonomy code is 225100000X with license number 310150 (CA). The provider is registered as an individual and her NPI record was last updated May 2026.
- NPI
- 1750268520
- Provider Name
- KELLY LYNN WALLACE DPT
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 6801 PARK TER STE 200 LOS ANGELES, CA 90045
- Location Phone
- (310) 665-7100
- Location Fax
- (310) 665-7101
- Mailing Address
- 780 E DORCHESTER DR SAINT JOHNS, FL 32259
- Medical School Name
- OTHER
- Graduation Year
- 2025
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 08-21-2025
- Last Update Date
- 05-26-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physical Therapist
- Taxonomy Code
- 225100000X
- Type
- Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- License No.
- 310150
- License State
- CA
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | PT43619 (FL) |
| 2 | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 1407872 (TX) |
Medicare Participation & PECOS Enrollment Status
Kelly Wallace is registered with Medicare but maybe doesn't accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
PECOS PAC ID: 3476057043
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20250917001570
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Maybe
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1750268520, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 60 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 12 providers are registered at the same or a nearby location.
LOS ANGELES, CA 90045
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1750268520, enumerated as an "individual" on August 21, 2025.
The provider is located at 6801 PARK TER STE 200 LOS ANGELES, CA 90045 and the phone number is (310) 665-7100.
Physical Therapist with taxonomy code 225100000X.
