Provider Demographics
NPI:1952952814
Name:MCLENDON, MANDY HORTON (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:HORTON
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-0219
Mailing Address - Country:US
Mailing Address - Phone:704-467-6818
Mailing Address - Fax:
Practice Address - Street 1:1247 1ST ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5501
Practice Address - Country:US
Practice Address - Phone:941-201-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist