Provider Demographics
NPI:1720593494
Name:VAN DIXHORN, HILARY PAIGE GEREAUX
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:PAIGE GEREAUX
Last Name:VAN DIXHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 LOMITA BLVD # 512
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1701
Mailing Address - Country:US
Mailing Address - Phone:310-922-3526
Mailing Address - Fax:
Practice Address - Street 1:25830 OAK ST UNIT 7
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3121
Practice Address - Country:US
Practice Address - Phone:310-922-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293942225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic