Provider Demographics
NPI:1821675844
Name:PACE, DYLAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11021 CEDAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-7855
Mailing Address - Country:US
Mailing Address - Phone:909-912-9587
Mailing Address - Fax:
Practice Address - Street 1:1632 PUENTE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5952
Practice Address - Country:US
Practice Address - Phone:626-430-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7619225100000X
CAPT299947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist