Provider Demographics
NPI:1578896841
Name:MEND PHYSIOTHERAPY LLC
Entity Type:Organization
Organization Name:MEND PHYSIOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:MONTAGUE
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:316-687-6363
Mailing Address - Street 1:3700 E DOUGLAS AVE
Mailing Address - Street 2:STE 30
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3700
Mailing Address - Country:US
Mailing Address - Phone:316-687-6363
Mailing Address - Fax:
Practice Address - Street 1:3700 E DOUGLAS AVE
Practice Address - Street 2:30
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3700
Practice Address - Country:US
Practice Address - Phone:316-687-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-023032251G0304X
KS11023032251X0800X
225200000X, 225400000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty