Provider Demographics
NPI:1588190599
Name:MENDA COCKING, LUAN (DPT)
Entity Type:Individual
Prefix:
First Name:LUAN
Middle Name:
Last Name:MENDA COCKING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 BROADMOOR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3716
Mailing Address - Country:US
Mailing Address - Phone:954-801-7271
Mailing Address - Fax:
Practice Address - Street 1:6840 BROADMOOR
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-3716
Practice Address - Country:US
Practice Address - Phone:954-801-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist