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General NPI Number Information
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NPI Number | 1831150705
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Entity Type | Individual
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Provider Name | BETSY A WALLACE PT OCS
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Gender | Female
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 3703 CAMINO DEL RIO S STE 100A
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City | SAN DIEGO
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State | CA
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Zip | 92108-4031
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Country | US
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Telephone | 619-269-2336
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Fax | 619-269-7608
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Provider Business Mailing Address
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Address Line | 600 S ANDREASEN DR STE C
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City | ESCONDIDO
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State | CA
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Zip | 92029-1917
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Country | US
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Telephone | 760-591-7750
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Fax | 760-294-9813
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT16506
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License Number State | CA
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