Doctor Name: | MRS. KELLY WALLACE |
NPI Number: | 1194892810 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 1050854 |
Business Practice Address: | 8619 Broadway St Ste 200 Pearland, TX - 775848496 |
Business Phone Number: | 2814854818 |
Business Fax Number: | 2814855446 |
Mailing Address: | 8619 Broadway St Ste 200, PEARLAND |
State: | TX |
Postal Code: | 775848496 |
Phone Number: | 2814854818 |
Fax Number: | 2814855446 |
NPI Enumeration Date: | 11/29/2006 |
NPI Last Update Date: | 08/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 1050854 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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 |