Organization Name: | MENDOTA PHYSICAL THERAPY LLC |
NPI Number: | 1487064507 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HEATHER LYN ENGELBERT (CLINIC OWNER, CLINICIAN) |
Mailing Address: | 750 Main St Suite 206 Mendota Heights |
State: | MN US |
Postal Code: | 551183764 |
Phone Number: | 6519059000 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2014 |
NPI Last Update Date: | 04/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |