Provider Demographics
NPI:1902602410
Name:LAO, DUSTIN C (DPT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:C
Last Name:LAO
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2262
Mailing Address - Country:US
Mailing Address - Phone:415-971-4883
Mailing Address - Fax:
Practice Address - Street 1:301 N LAKE AVE STE 201
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5120
Practice Address - Country:US
Practice Address - Phone:626-568-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3076232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic