Provider Demographics
NPI:1710290069
Name:MENTZER, JOSE MARI BLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE MARI
Middle Name:BLAS
Last Name:MENTZER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43217 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1812
Mailing Address - Country:US
Mailing Address - Phone:586-838-9256
Mailing Address - Fax:586-601-2787
Practice Address - Street 1:43217 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1812
Practice Address - Country:US
Practice Address - Phone:586-838-9256
Practice Address - Fax:586-601-2787
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist