Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 41630 | CA |
N | 2251S0007X | Physical Therapist - Sports | 41630 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 41630 | CA |
NPI | 1093119729 |
---|---|
Provider Name | Tyler Duane Dorrel |
First Address | Montebello, CA 90640-4265 |
Second Address | Brea, CA 92821-4370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 31/03/2020 |