Provider Demographics
NPI:1902241490
Name:LUNA, MENDY (PTA)
Entity Type:Individual
Prefix:
First Name:MENDY
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:706 WOODSON DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-1300
Mailing Address - Country:US
Mailing Address - Phone:979-218-0302
Mailing Address - Fax:
Practice Address - Street 1:1022 STATE HIGHWAY 21 E
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-4611
Practice Address - Country:US
Practice Address - Phone:979-567-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist