Individual
KEVIN MANDALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1485 S HIGHWAY 40, HEBER CITY, UT 84032-3522
(435) 654-2500
Mailing address
24951 NORTH CIRCLE DRIVE, NICHOL HALL, RM 1809, LOMA LINDA, CA 92354
(909) 558-8108
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9161047-2401
UT
225100000X
Physical Therapist
PTP-PT-LIC-7574
MT
Other
Enumeration date
07/31/2014
Last updated
01/05/2015
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