Provider Demographics
NPI:1568418887
Name:MENTEL, JEFFREY (MPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:MENTEL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61651
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-1651
Mailing Address - Country:US
Mailing Address - Phone:337-769-1556
Mailing Address - Fax:337-769-1557
Practice Address - Street 1:101 PARK WEST DR
Practice Address - Street 2:STE. B
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8902
Practice Address - Country:US
Practice Address - Phone:337-769-1556
Practice Address - Fax:337-769-1557
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C783C824Medicare Oscar/Certification