Individual
MRS. CAROL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
13210 RUSSET LEAF LN, SAN DIEGO, CA 92129-2368
(858) 277-2277
Mailing address
13210 RUSSET LEAF LN, SAN DIEGO, CA 92129-2368
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT9008
CA
Other
Enumeration date
10/27/2006
Last updated
07/08/2007
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