Provider Demographics
NPI:1790956316
Name:MENDOZA, MARISON MAGNO (PT)
Entity type:Individual
Prefix:MRS
First Name:MARISON
Middle Name:MAGNO
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARISON
Other - Middle Name:MILLORA
Other - Last Name:MAGNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7604 TAMSIN CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3752
Mailing Address - Country:US
Mailing Address - Phone:443-850-0475
Mailing Address - Fax:
Practice Address - Street 1:1601 E BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3004
Practice Address - Country:US
Practice Address - Phone:410-532-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist