Provider Demographics
NPI:1417169483
Name:MENDOZA, MICHAEL F (ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 OLD ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1720
Mailing Address - Country:US
Mailing Address - Phone:440-376-7381
Mailing Address - Fax:
Practice Address - Street 1:171 OLD ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-1720
Practice Address - Country:US
Practice Address - Phone:440-376-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer