Provider Demographics
NPI:1457927154
Name:MENDOZA, CHARMAINE V (PT)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:V
Last Name:MENDOZA
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 1:505 E. LAMAR BLVD.
Mailing Address - Street 2:STE. 374
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3940
Mailing Address - Country:US
Mailing Address - Phone:254-488-1779
Mailing Address - Fax:
Practice Address - Street 1:505 E. LAMAR BLVD.
Practice Address - Street 2:STE. 374
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3940
Practice Address - Country:US
Practice Address - Phone:254-488-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1257710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist