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NPI Code Detail

MEDICARE: MRS. OLGA LUCIA MENDEZ-STANKEVICH RPT

MEDICARE: MRS. OLGA LUCIA MENDEZ-STANKEVICH RPT
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
1225100000XPhysical Therapist05007054AIN
2225100000XPhysical Therapist10926-24WI

General Provider Information

NPI Number : 1518031764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. OLGA LUCIA MENDEZ-STANKEVICH RPT
Provider Business Mailing Address
First Line : 2475 CLEAR BROOK CIR
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-3977
Country : US
Telephone Number : 920-634-2844
Fax Number :
Provider Business Practice Location Address
First Line : 1160 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8321
Country : US
Telephone Number : 920-288-4712
Fax Number : 920-288-4707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 10/24/2018

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