Provider Demographics
NPI:1902452683
Name:MENDLER, ALICIA MEI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MEI
Last Name:MENDLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MEI
Other - Last Name:IRIKURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5423 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1627
Mailing Address - Country:US
Mailing Address - Phone:240-478-5695
Mailing Address - Fax:
Practice Address - Street 1:3701 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5613
Practice Address - Country:US
Practice Address - Phone:510-752-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist