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General NPI Number Information
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NPI Number | 1487373544
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Entity Type | Individual
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Provider Name | MICAELA ANGELA MENDIETTA
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Gender | Female
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 410 N PALAFOX ST
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City | PENSACOLA
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State | FL
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Zip | 32501-3919
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Country | US
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Telephone | 850-458-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 402 E MAIN ST
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City | BISHOP
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State | TX
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Zip | 78343-2650
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Country | US
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Telephone | 361-355-6971
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1367179
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License Number State | TX
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