Provider Demographics
NPI:1023146461
Name:DIZON, ALLAN P (MPT)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:P
Last Name:DIZON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:ALLAN
Other - Middle Name:P
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:2661 OLYMPIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1306
Mailing Address - Country:US
Mailing Address - Phone:909-636-8394
Mailing Address - Fax:909-636-8394
Practice Address - Street 1:1950 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6723
Practice Address - Country:US
Practice Address - Phone:909-467-6183
Practice Address - Fax:909-983-5814
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT238752251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ24373Medicare UPIN