Provider Demographics
NPI:1922400969
Name:MENDEZONA, EDWINA ATILLO (PT)
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:ATILLO
Last Name:MENDEZONA
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 1:1932 CAPRICE DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-8658
Mailing Address - Country:US
Mailing Address - Phone:209-535-2138
Mailing Address - Fax:
Practice Address - Street 1:2001 MCHENRY AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3245
Practice Address - Country:US
Practice Address - Phone:209-846-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist