Kelly Wallace, RPT

NPI #1184696023 in Choctaw, Oklahoma

Provider Information

NPI Number: 1184696023
Entity Type: Individual
Name: Kelly Wallace, RPT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: RPT
Enumeration Date: Feb 5, 2006
Last Updated: Apr 27, 2015

Practice Location

Address: 13390 NE 23RD ST
City: Choctaw
State: Oklahoma
ZIP Code: 73020-8622
Phone: (405) 769-5555

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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