Provider Demographics
NPI:1538214416
Name:MENDOZA, ARMEL (PT)
Entity type:Individual
Prefix:MR
First Name:ARMEL
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ARMEL
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 CHESTNUT ST
Mailing Address - Street 2:STE. 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3401
Mailing Address - Country:US
Mailing Address - Phone:512-564-1110
Mailing Address - Fax:215-564-1130
Practice Address - Street 1:1919 CHESTNUT ST
Practice Address - Street 2:STE. 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3401
Practice Address - Country:US
Practice Address - Phone:512-564-1110
Practice Address - Fax:215-564-1130
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009930L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111959WQNMedicare PIN