Provider Demographics
NPI:1801866777
Name:MARDINI, MAY (PT)
Entity Type:Individual
Prefix:
First Name:MAY
Middle Name:
Last Name:MARDINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 N CALIFORNIA ST
Mailing Address - Street 2:STE 4
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3433
Mailing Address - Country:US
Mailing Address - Phone:209-473-3272
Mailing Address - Fax:
Practice Address - Street 1:3215 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3433
Practice Address - Country:US
Practice Address - Phone:209-464-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT175990Medicare UPIN