Healthcare Provider Details

I. General information

NPI: 1275414724
Provider Name (Legal Business Name): KWALK KIDS- PHYSICAL THERAPY & WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 NEW MILLS RD
SAN DIEGO CA
92115-2247
US

IV. Provider business mailing address

5433 NEW MILLS RD
SAN DIEGO CA
92115-2247
US

V. Phone/Fax

Practice location:
  • Phone: 760-960-1654
  • Fax:
Mailing address:
  • Phone: 760-960-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELSEY WALK
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 760-960-1654