Provider Demographics
NPI:1558598326
Name:MENDOZA, KATHERINE ANN KAREN CANO (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE ANN KAREN
Middle Name:CANO
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31270 SPRINGLAKE BLVD
Mailing Address - Street 2:APT. 2302
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1124
Mailing Address - Country:US
Mailing Address - Phone:410-206-5064
Mailing Address - Fax:
Practice Address - Street 1:31270 SPRINGLAKE BLVD
Practice Address - Street 2:APT. 2302
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1124
Practice Address - Country:US
Practice Address - Phone:410-206-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013312225100000X
NM3682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist