Healthcare Provider Details

I. General information

NPI: 1225332810
Provider Name (Legal Business Name): JESSICA MENDOZA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LIND AVE SW STE 160
RENTON WA
98057-4934
US

IV. Provider business mailing address

3600 LIND AVE SW STE 160
RENTON WA
98057-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4215
  • Fax: 425-656-5075
Mailing address:
  • Phone: 425-656-4215
  • Fax: 425-656-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60169486
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: