Individual
TAMARA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
333 GELLERT BLVD, #150, DALY CITY, CA 94015-2621
(650) 758-4700
Mailing address
555 4TH ST, APT 826, SAN FRANCISCO, CA 94107-1604
(916) 205-1299
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT6816
CA
Other
Enumeration date
08/09/2011
Last updated
08/09/2011
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