Provider Demographics
NPI:1093119729
Name:DORREL, TYLER DUANE (MPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:DUANE
Last Name:DORREL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W BEVERLY BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4265
Mailing Address - Country:US
Mailing Address - Phone:562-991-1324
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAMBERT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4370
Practice Address - Country:US
Practice Address - Phone:714-256-5074
Practice Address - Fax:714-256-0770
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416302251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic