Individual
MS. VIVIAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1575 7TH AVE, SAN FRANCISCO, CA 94122-3704
(415) 566-1200
Mailing address
767 CHESTNUT AVE, SAN BRUNO, CA 94066-3323
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2718
CA
Other
Enumeration date
05/22/2008
Last updated
05/22/2008
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