Healthcare Provider Details

I. General information

NPI: 1649646589
Provider Name (Legal Business Name): ROBERTO MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

1354 BUCKINGHAM RD
WINTER PARK FL
32789-5506
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT16481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: