Provider Demographics
NPI:1265670343
Name:TONELLI, YEDDA GAN MARCELINO (DPT ATC)
Entity type:Individual
Prefix:
First Name:YEDDA
Middle Name:GAN MARCELINO
Last Name:TONELLI
Suffix:
Gender:
Credentials:DPT ATC
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1908 GRANT AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3527
Mailing Address - Country:US
Mailing Address - Phone:805-796-7084
Mailing Address - Fax:
Practice Address - Street 1:520 N PROSPECT AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3033
Practice Address - Country:US
Practice Address - Phone:310-376-9222
Practice Address - Fax:310-376-9888
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
CA34824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic