Provider Demographics
NPI:1659922581
Name:SPETZMAN, DYLAN (PTA)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:SPETZMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 LARWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3512
Mailing Address - Country:US
Mailing Address - Phone:714-308-5798
Mailing Address - Fax:
Practice Address - Street 1:5122 KATELLA AVE STE 16
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2838
Practice Address - Country:US
Practice Address - Phone:562-795-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49920225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant