Healthcare Provider Details

I. General information

NPI: 1275682262
Provider Name (Legal Business Name): WENDELL B MENDENHALL MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 RED PINE DR
ALPINE UT
84004-1557
US

IV. Provider business mailing address

568 RANCH CIR
ALPINE UT
84004-1972
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-7061
  • Fax: 801-756-7043
Mailing address:
  • Phone: 801-756-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number120899-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: