Provider Demographics
NPI:1609151984
Name:BOTTA, DIANNE MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:BOTTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 METROPOLITAN DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4404
Mailing Address - Country:US
Mailing Address - Phone:844-316-7979
Mailing Address - Fax:866-813-1235
Practice Address - Street 1:405 N TWIN OAKS VALLEY RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2954
Practice Address - Country:US
Practice Address - Phone:844-316-7979
Practice Address - Fax:866-813-1235
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA293777OtherPHYSICAL THERAPY BOARD OF CA