Provider Demographics
NPI:1003143041
Name:TESORIO, CLYTIC MARIE VILLAS (PT-DPT)
Entity Type:Individual
Prefix:MS
First Name:CLYTIC MARIE
Middle Name:VILLAS
Last Name:TESORIO
Suffix:
Gender:F
Credentials:PT-DPT
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 SLAUSON AVE.
Mailing Address - Street 2:UNIT H
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606
Mailing Address - Country:US
Mailing Address - Phone:562-693-5449
Mailing Address - Fax:562-693-5469
Practice Address - Street 1:12411 SLAUSON AVE.
Practice Address - Street 2:UNIT H
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606
Practice Address - Country:US
Practice Address - Phone:562-693-5449
Practice Address - Fax:562-693-5469
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics