Provider Demographics
NPI:1518995844
Name:MESTRICH, JEFFREY DENNIS (PT, DSC, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DENNIS
Last Name:MESTRICH
Suffix:
Gender:M
Credentials:PT, DSC, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17471 WHEELER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-6903
Mailing Address - Country:US
Mailing Address - Phone:317-275-6131
Mailing Address - Fax:317-275-7140
Practice Address - Street 1:17471 WHEELER RD STE 114
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074
Practice Address - Country:US
Practice Address - Phone:317-275-6131
Practice Address - Fax:317-275-7140
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008033A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist