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Individual

BETSY A WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT OCS

Contact information

Practice address
3703 CAMINO DEL RIO S, STE 100A, SAN DIEGO, CA 92108-4031
(619) 269-2336
(619) 269-7608
Mailing address
600 S ANDREASEN DR, STE C, ESCONDIDO, CA 92029-1917
(760) 591-7750
(760) 294-9813

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT16506
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CW038X
MEDICARE
CA
01
CW038Y
MEDICARE
CA
01
CW038Z
MEDICARE
CA
Enumeration date
03/30/2006
Last updated
03/26/2010
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