Provider Demographics
NPI:1629097795
Name:ANDALON, DAWN DIMITRIS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:DIMITRIS
Last Name:ANDALON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:E
Other - Last Name:DIMITRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:171 SAXONY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6776
Mailing Address - Country:US
Mailing Address - Phone:760-503-4440
Mailing Address - Fax:
Practice Address - Street 1:171 SAXONY RD STE 105
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6776
Practice Address - Country:US
Practice Address - Phone:760-503-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR601202251X0800X
CA29362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty