| Doctor Name: | KEVIN MANDALA |
| NPI Number: | 1023426160 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | PTP-PT-LIC-7574 |
| Business Practice Address: | 1485 S Highway 40 Heber City, UT - 840323522 |
| Business Phone Number: | 4356542500 |
| Business Fax Number: | |
| Mailing Address: | 24951 North Circle Drive, Nichol Hall, Rm 1809 LOMA LINDA |
| State: | CA |
| Postal Code: | 92354 |
| Phone Number: | 9095588108 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2014 |
| NPI Last Update Date: | 01/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PTP-PT-LIC-7574 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |