Individual
MIKE A MENDIOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
1004 PROGRESS DR, STE 100, LANSING, KS 66043-6326
(913) 351-3838
(913) 351-3939
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070012819
IL
225100000X
Physical Therapist
Primary
11-04998
KS
225100000X
Physical Therapist
2015003684
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
753561
OPTUM
—
01
—
KA2868072
MEDICARE PTAN
KS
01
—
MA4370099
MEDICARE PTAN
MO
01
—
USES NPI
BCBS-KANSAS
KS
Enumeration date
02/12/2007
Last updated
04/24/2015
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