1578592424 NPI number — REDONDO ORTHOPEDIC PHYSICAL THERAPY

Table of content: DR. WILLIAM LEWIS DILLEN M.D. (NPI 1902240013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578592424 NPI number — REDONDO ORTHOPEDIC PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDONDO ORTHOPEDIC PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578592424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 N PROSPECT AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-376-9222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23133 HAWTHORNE BLVD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-3729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-321-4056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TYSSEE
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-376-9222

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT23254 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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