MEDICARE: MENDOTA PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1487064507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDOTA PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1270 NORTHLAND DR STE 175
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1412
Country	:	US
Telephone Number	:	651-905-9000
Fax Number	:	651-454-1603

Provider Business Practice Location Address
First Line	:	1270 NORTHLAND DR STE 175
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1412
Country	:	US
Telephone Number	:	651-905-9000
Fax Number	:	651-454-1603

Authorized Official
Title or Position	:	CLINIC OWNER, CLINICIAN
Name	:	HEATHER LYN ENGELBERT
Credential	:	MPT
Telephone Number	:	651-905-9000

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	10/26/2022

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Directions to “MENDOTA PHYSICAL THERAPY LLC ” Practice Location

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