Provider Demographics
NPI:1417594565
Name:CERPA TYLER, MARIANDREA (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:MARIANDREA
Middle Name:
Last Name:CERPA TYLER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 PHILADELPHIA ST STE C103
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2250
Mailing Address - Country:US
Mailing Address - Phone:909-590-7997
Mailing Address - Fax:
Practice Address - Street 1:4541 PHILADELPHIA ST STE C103
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2250
Practice Address - Country:US
Practice Address - Phone:909-590-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic