Doctor Name: | MR. JACEK WLADYSLAW MENDALA |
NPI Number: | 1710107172 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 05007301A |
Business Practice Address: | 1866 W 85th Ave Apt. J 275 Merrillville, IN - 464108478 |
Business Phone Number: | 2197939902 |
Business Fax Number: | |
Mailing Address: | 3110 N Milwaukee Ave, Apt.3f CHICAGO |
State: | IL |
Postal Code: | 606186622 |
Phone Number: | 1219793990 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05007301A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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 |