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NPI Code Detail

MEDICARE: DYLAN PACE PT, DPT

MEDICARE: DYLAN PACE PT, DPT
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
1225100000XPhysical TherapistPT-7619ID
2225100000XPhysical TherapistPT299947CA

General Provider Information

NPI Number : 1821675844
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN PACE PT, DPT
Provider Business Mailing Address
First Line : 11021 CEDAR CREEK DR
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91737-7855
Country : US
Telephone Number : 909-912-9587
Fax Number :
Provider Business Practice Location Address
First Line : 1632 PUENTE AVE
Second Line :
City : BALDWIN PARK
State : CA
Zip : 91706-5952
Country : US
Telephone Number : 626-430-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 10/13/2021

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