Provider Demographics
NPI:1881323418
Name:MENDOZA, KATHRINA CAYABYAB (DPT, PT)
Entity type:Individual
Prefix:
First Name:KATHRINA
Middle Name:CAYABYAB
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0179
Mailing Address - Country:US
Mailing Address - Phone:410-676-6767
Mailing Address - Fax:410-676-6770
Practice Address - Street 1:1411 S MOUNTAIN RD STE D
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3202
Practice Address - Country:US
Practice Address - Phone:410-676-6767
Practice Address - Fax:410-676-6770
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045591-01225100000X
NY012432-01225200000X
MD29707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant