Healthcare Provider Details

I. General information

NPI: 1750760997
Provider Name (Legal Business Name): MELISSA MENDINI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N MAIN ST
CEDAR CITY UT
84721-9746
US

IV. Provider business mailing address

1303 N MAIN ST
CEDAR CITY UT
84721-9746
US

V. Phone/Fax

Practice location:
  • Phone: 435-868-5000
  • Fax:
Mailing address:
  • Phone: 435-868-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8820495-4810
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: