Active NPI
Leodegard Dyoco, R.P.T.
- Physical Therapist
- Fontana, CA
National Provider Identifier
1508017708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 28803
- Practice address
- 5878 Backus Peak Way
Fontana, CA 92336-4584 - Phone
- (909) 427-0693
- NPI assigned
- Oct 7, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 28803 | CA | Primary |
Addresses
Primary practice location
5878 Backus Peak Way
Fontana, CA 92336-4584
Mailing address
5878 Backus Peak Way
Fontana, CA 92336-4584
Phone (909) 427-0693
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 28803 | CA | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223337600000",
"number": "1508017708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5878 BACKUS PEAK WAY",
"city": "FONTANA",
"state": "CA",
"postal_code": "923364584",
"telephone_number": "909-427-0693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5878 BACKUS PEAK WAY",
"city": "FONTANA",
"state": "CA",
"postal_code": "923364584",
"telephone_number": "909-427-0693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYOCO",
"first_name": "LEODEGARD",
"credential": "R.P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-07",
"last_updated": "2008-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 28803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.