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General NPI Number Information
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NPI Number | 1487064507
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Entity Type | Organization
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Legal Business Name | MENDOTA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1270 NORTHLAND DR STE 175
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1412
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Country | US
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Telephone | 651-905-9000
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Fax | 651-454-1603
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Provider Business Mailing Address
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Address Line | 1270 NORTHLAND DR STE 175
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1412
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Country | US
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Telephone | 651-905-9000
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Fax | 651-454-1603
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Authorized Official
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Title or Position | CLINIC OWNER, CLINICIAN
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Name | HEATHER LYN ENGELBERT
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Credential | MPT
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Telephone | 651-905-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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