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General NPI Number Information
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NPI Number | 1639978000
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Entity Type | Individual
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Provider Name | DESIREE TADWILLIAMS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2010 WILSHIRE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90403-5608
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Country | US
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Telephone | 310-878-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 5550 GROSVENOR BLVD APT 221
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City | LOS ANGELES
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State | CA
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Zip | 90066-7310
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Country | US
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Telephone | 909-996-9342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 307757
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License Number State | CA
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