Provider Demographics
NPI:1508671512
Name:MENDOZA, RYAN DAMIAN (PTA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAMIAN
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 SW 167TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4646
Mailing Address - Country:US
Mailing Address - Phone:954-918-4246
Mailing Address - Fax:
Practice Address - Street 1:11750 CANAL ST UNIT 203
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7823
Practice Address - Country:US
Practice Address - Phone:954-918-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31676225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty