MR. Jason Scott Wallace, PTA
NPI #1891786646 in Camarillo, California
Provider Information
- NPI Number
- 1891786646
- Entity Type
- Individual
- Name
- MR. Jason Scott Wallace, PTA
- Gender
- Not Specified
- Sole Proprietor
- Not Answered
- Primary Specialty
- Physical Therapy Assistant
- Credential
- PTA
- Enumeration Date
- Nov 1, 2005
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 2486 N PONDEROSA DR
- Address 2
- STE D-106
- City
- Camarillo
- State
- California
- ZIP Code
- 93010-2376
- Phone
- (805) 484-5447
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapy Assistant |
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