Jacek Wladyslaw Mendala, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05007301A Issued in IN

Practice address

1866 W 85TH Ave
Apt. J 275
Merrillville, IN 46410-8478

Phone

(219) 793-9902

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710107172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 N MILWAUKEE AVE",
            "address_2": "APT.3F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186622",
            "telephone_number": "121-979-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1866 W 85TH AVE",
            "address_2": "APT. J 275",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464108478",
            "telephone_number": "219-793-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDALA",
        "first_name": "JACEK",
        "middle_name": "WLADYSLAW",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05007301A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Merrillville, IN
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.