Provider Demographics
NPI:1346200326
Name:MENDOZA, MA. THERESA VILLARTA (PT)
Entity Type:Individual
Prefix:
First Name:MA. THERESA
Middle Name:VILLARTA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CORTEZ RD W
Mailing Address - Street 2:SUITE A4
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3119
Mailing Address - Country:US
Mailing Address - Phone:941-254-4954
Mailing Address - Fax:
Practice Address - Street 1:3633 CORTEZ RD W
Practice Address - Street 2:SUITE A4
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3119
Practice Address - Country:US
Practice Address - Phone:941-254-4954
Practice Address - Fax:941-254-4955
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist