Individual provider Active NPI

Yedda Gan Marcelino Tonelli, DPT ATC

  • Physical Therapist
  • Redondo Beach, CA
National Provider Identifier
1265670343
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
34824 Issued in CA
Practice address
520 N Prospect Ave Ste 100
Redondo Beach, CA 90277-3033
Phone
(310) 376-9222
Fax
(310) 376-9888
NPI assigned
Jan 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X CA
Physical Therapist 225100000X 34824 CA Primary

Addresses

Primary practice location

520 N Prospect Ave Ste 100
Redondo Beach, CA 90277-3033

Mailing address

1908 Grant Ave Unit E
Redondo Beach, CA 90278-3527
Phone (805) 796-7084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090622000501 CA Practitioner - Physical Therapist in Private Practice 0840341475 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Mar 6, 2025 Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1265670343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 GRANT AVE UNIT E",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783527",
            "telephone_number": "805-796-7084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N PROSPECT AVE STE 100",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773033",
            "telephone_number": "310-376-9222",
            "fax_number": "310-376-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TONELLI",
        "first_name": "YEDDA",
        "middle_name": "GAN MARCELINO",
        "credential": "DPT ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-28",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "34824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.