MEDICARE: JOSEFINA MENDOZA P.T.

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	225100000X	Physical Therapist		FL

General Provider Information

NPI Number	:	1568659258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFINA MENDOZA P.T.

Provider Business Mailing Address
First Line	:	1395 N COURTENAY PKWY STE 102
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4474
Country	:	US
Telephone Number	:	321-986-8812
Fax Number	:	321-986-8814

Provider Business Practice Location Address
First Line	:	1395 N COURTENAY PKWY STE 102
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4474
Country	:	US
Telephone Number	:	321-986-8812
Fax Number	:	321-986-8814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	01/15/2014

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