Provider Demographics
NPI:1982018180
Name:MENDEZ, DANIELLE (PT, MSPT, OCS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:PT, MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15A WICKATUNK RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2719
Mailing Address - Country:US
Mailing Address - Phone:732-322-9137
Mailing Address - Fax:
Practice Address - Street 1:3 JOANNA CT STE E
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2283
Practice Address - Country:US
Practice Address - Phone:732-631-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01553300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist