MEDICARE: JILLE A. DORLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT16500	CA

General Provider Information

NPI Number	:	1588612295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILLE A. DORLER

Provider Business Mailing Address
First Line	:	234 S PACIFIC COAST HWY
Second Line	:	SUITE #204
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3383
Country	:	US
Telephone Number	:	310-798-9889
Fax Number	:	310-798-4111

Provider Business Practice Location Address
First Line	:	234 S PACIFIC COAST HWY
Second Line	:	SUITE #204
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3383
Country	:	US
Telephone Number	:	310-798-9889
Fax Number	:	310-798-4111

Authorized Official
Title or Position	:	OWNER PHYSICAL THERAPIST
Name	:	JILLE ALEXANDRA DORLER
Credential	:	P.T.
Telephone Number	:	310-798-9889

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/20/2008

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