Individual
DIANE RUTH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9000 WAKARUSA ST, LA MESA, CA 91942-3307
(619) 740-4600
Mailing address
2033 ARROW CT, EL CAJON, CA 92019-4226
(619) 440-3754
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT250
CA
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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