Provider Demographics
NPI:1578601647
Name:MENDELSON, LAURA EDELSTEIN (PT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:EDELSTEIN
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EDELSTEIN
Other - Middle Name:PHYSICAL
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:11992 BARNESWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1301
Mailing Address - Country:US
Mailing Address - Phone:513-884-4664
Mailing Address - Fax:513-489-1266
Practice Address - Street 1:11992 BARNESWOOD CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1301
Practice Address - Country:US
Practice Address - Phone:513-884-4664
Practice Address - Fax:513-489-1266
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist