Provider Demographics
NPI:1750619573
Name:MENDELSON, YELENA (LMT)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENSPRING VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4136
Mailing Address - Country:US
Mailing Address - Phone:410-654-8997
Mailing Address - Fax:410-654-8449
Practice Address - Street 1:8 GREENSPRING VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4136
Practice Address - Country:US
Practice Address - Phone:410-654-8997
Practice Address - Fax:410-654-8449
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist