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1265642730
DIANE RUTH WALLACE
LA MESA, CA
NPI
1265642730
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: CA AT250)
Enumeration Date
2007-05-23
Last Update Date
2007-07-08
Business Address
-- DIANE RUTH WALLACE PTA
9000 WAKARUSA ST
LA MESA, CA 91942-3307
Phone number: 619-740-4600
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Mailing Address
-- DIANE RUTH WALLACE PTA
2033 ARROW CT
EL CAJON, CA 92019-4226
Phone number: 619-440-3754
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