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General NPI Number Information
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NPI Number | 1023728813
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Entity Type | Individual
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Provider Name | MARC A MENDOZA
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Gender | Male
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 6805 INDUSTRIAL RD STE 3100
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City | SPRINGFIELD
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State | VA
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Zip | 22151-4206
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Country | US
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Telephone | 703-256-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 7236 EVANSTON RD
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City | SPRINGFIELD
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State | VA
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Zip | 22150-3625
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Country | US
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Telephone | 703-229-7541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305216266
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License Number State | VA
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