Provider Demographics
NPI:1881631679
Name:MENDOZA, RAHNEEL (PT)
Entity Type:Individual
Prefix:
First Name:RAHNEEL
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6289 N CICERO AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4917
Mailing Address - Country:US
Mailing Address - Phone:773-725-8025
Mailing Address - Fax:773-725-8025
Practice Address - Street 1:6289 N CICERO AVE
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4917
Practice Address - Country:US
Practice Address - Phone:773-725-8025
Practice Address - Fax:773-725-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist