Provider Demographics
NPI:1578364691
Name:MENDOZA, DYANA (DPT)
Entity type:Individual
Prefix:
First Name:DYANA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3556
Mailing Address - Country:US
Mailing Address - Phone:701-258-1569
Mailing Address - Fax:701-223-1669
Practice Address - Street 1:1138 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3556
Practice Address - Country:US
Practice Address - Phone:701-258-1569
Practice Address - Fax:701-223-1669
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist