Individual
KATHRYN NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
320 ALISAL RD STE 406, SOLVANG, CA 93463-3750
(805) 688-5000
Mailing address
5560 EL POMAR DR, TEMPLETON, CA 93465-8555
(805) 610-0657
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
42600
CA
Other
Enumeration date
05/21/2015
Last updated
05/22/2015
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