Provider Demographics
NPI:1588612295
Name:JILLE A. DORLER
Entity type:Organization
Organization Name:JILLE A. DORLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILLE
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:DORLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-798-9889
Mailing Address - Street 1:234 S PACIFIC COAST HWY
Mailing Address - Street 2:SUITE #204
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3383
Mailing Address - Country:US
Mailing Address - Phone:310-798-9889
Mailing Address - Fax:310-798-4111
Practice Address - Street 1:234 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE #204
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3383
Practice Address - Country:US
Practice Address - Phone:310-798-9889
Practice Address - Fax:310-798-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17325Medicare PIN