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NPI Code Detail

MEDICARE: KATHRYN WALLACE DPT

MEDICARE: KATHRYN WALLACE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPTL89046MA

General Provider Information

NPI Number : 1447107214
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN WALLACE DPT
Provider Business Mailing Address
First Line : 7 RESERVOIR RD
Second Line :
City : BEVERLY
State : MA
Zip : 01915-5501
Country : US
Telephone Number : 978-524-0333
Fax Number : 978-524-0334
Provider Business Practice Location Address
First Line : 7 RESERVOIR RD
Second Line :
City : BEVERLY
State : MA
Zip : 01915-5501
Country : US
Telephone Number : 978-524-0333
Fax Number : 978-524-0334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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