Provider Demographics
NPI:1205059789
Name:MENDICK, THOMAS JEFFREY (LMT,NCTMB)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEFFREY
Last Name:MENDICK
Suffix:
Gender:M
Credentials:LMT,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 SAPP BROTHERS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-3951
Mailing Address - Country:US
Mailing Address - Phone:402-214-4055
Mailing Address - Fax:
Practice Address - Street 1:9905 SAPP BROTHERS DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3951
Practice Address - Country:US
Practice Address - Phone:402-214-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist