Provider Demographics
NPI:1851579239
Name:MENDOZA, MANOLITA ANTEROLA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MANOLITA
Middle Name:ANTEROLA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MANOLITA
Other - Middle Name:
Other - Last Name:ANTEROLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:6374 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6374 76TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1302
Practice Address - Country:US
Practice Address - Phone:212-203-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist