Healthcare Provider Details

I. General information

NPI: 1851256218
Provider Name (Legal Business Name): SHAUN VIDAL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 ARTESIA BLVD STE Q
TORRANCE CA
90504-2963
US

IV. Provider business mailing address

22722 CERISE AVE
TORRANCE CA
90505-2918
US

V. Phone/Fax

Practice location:
  • Phone: 310-714-3010
  • Fax:
Mailing address:
  • Phone: 310-714-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number305429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: