Healthcare Provider Details

I. General information

NPI: 1578364691
Provider Name (Legal Business Name): DYANA SELENA MENDOZA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13951 W GRAND AVE
SURPRISE AZ
85374-2436
US

IV. Provider business mailing address

360 EVERGREEN AVE
TEQUESTA FL
33469-2957
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-9730
  • Fax:
Mailing address:
  • Phone: 561-662-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309564
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034877
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2808
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: