Individual
DIANE WING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 N PROSPECT AVE, SUITE 100, REDONDO BEACH, CA 90277-3041
(310) 376-9222
Mailing address
727 ANITA ST, REDONDO BEACH, CA 90278-4705
(310) 376-9222
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT20291
PT LICENSE
CA
Enumeration date
07/07/2006
Last updated
02/13/2008
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