| Doctor Name: | KIMBERLY WALLACE |
| NPI Number: | 1114926698 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | PT007970L |
| Business Practice Address: | 420 Bainbridge St 453 Lower Indian Head Road Philadelphia, PA - 191471568 |
| Business Phone Number: | 2156293837 |
| Business Fax Number: | 2156295531 |
| Mailing Address: | 420 Bainbridge St, 453 Lower Indian Head Road PHILADELPHIA |
| State: | PA |
| Postal Code: | 191471568 |
| Phone Number: | 2156293837 |
| Fax Number: | 2156295531 |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 04/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT007970L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |