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Individual
KELLY LYNN WALLACE
Active
Individual
KELLY LYNN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1407872
TX
225100000X
Physical Therapist
Primary
310150
CA
225100000X
Physical Therapist
PT43619
FL
Other
Enumeration date
08/21/2025
Last updated
05/26/2026
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