Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1245474196 |
---|---|
Provider Name | Diane Fons |
First Address | San Diego, CA 92109-3595 |
Second Address | San Diego, CA 92109-3595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 23/11/2011 |