Individual
MRS. DYWANA CAROLYN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1 CIVIC PLAZA DR, SUITE 625, CARSON, CA 90745-2243
(310) 549-4500
Mailing address
23357 BALMORAL LN, WEST HILLS, CA 91307-1431
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 3079
CA
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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