KELLY WALLACE (RPT) – Physical Therapist, NPI 1184696023
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
845 PHYSICAL THERAPIST IN PRIVATE PRACTICE in OK
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Provider Addresses for KELLY WALLACE (RPT)
13390, Northeast 23rd Street, Choctaw, Oklahoma County, Oklahoma, 73020, United States
CHOCTAW, OK 730208622
Phone: (405) 769-5555
Fax: (405) 769-5558
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-04-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100416000047 | I | Physical Therapist In Private Practice | OK | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 1,248 | 108 | $0 |
| 97140 | Therapy procedure using manual technique, each 15 minutes | 1,110 | 99 | $0 |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 1,058 | 105 | $0 |
| 97150 | Therapy procedure in a group setting | 500 | 81 | $0 |
| 97530 | Therapy procedure using functional activities | 324 | 54 | $0 |
Insurance plans in this area (ZIP 73020)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICAL THERAPY | OK | 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 500 | 35 |
| PHYSICAL THERAPY | OK | 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 356 | 33 |
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