Provider Demographics
NPI:1992855472
Name:MENDEZ, ANA LAURA
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LAURA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:389 COMMERCIAL COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-8244
Mailing Address - Country:US
Mailing Address - Phone:941-488-6600
Mailing Address - Fax:941-488-6621
Practice Address - Street 1:389 COMMERCIAL COURT
Practice Address - Street 2:SUITE C
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3125
Practice Address - Country:US
Practice Address - Phone:941-488-6600
Practice Address - Fax:941-488-6621
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT134842251G0304X, 2251S0007X
FLPT134672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7434OtherINDIVIDUAL BLUE CROSS
FLY7434ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE