Healthcare Provider Details

I. General information

NPI: 1710663398
Provider Name (Legal Business Name): LEONARDO MENDOZA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 PAT BOOKER RD STE 120
LIVE OAK TX
78233-2776
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 210-660-2345
  • Fax: 210-446-1442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3131625
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1380242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: