Active NPI
Edwina Atillo Mendezona, P.T.
- Physical Therapist
- Modesto, CA
National Provider Identifier
1922400969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 25591
- Practice address
- 2001 McHenry Ave
Suite G
Modesto, CA 95350-3245 - Phone
- (209) 846-8282
- NPI assigned
- Sep 22, 2014
- Last updated
- Sep 23, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 25591 | CA | Primary |
Addresses
Primary practice location
2001 McHenry Ave
Suite G
Modesto, CA 95350-3245
Mailing address
1932 Caprice Dr
Turlock, CA 95382-8658
Phone (209) 535-2138
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25591 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
| PT 25591 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nifty After Fifty | Physical Therapist | Past | Accepting new patients |
| Naf Physical Therapy Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Katy, TX
- NPI 1831429687
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411430400000",
"number": "1922400969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1932 CAPRICE DR",
"city": "TURLOCK",
"state": "CA",
"postal_code": "953828658",
"telephone_number": "209-535-2138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 MCHENRY AVE",
"address_2": "SUITE G",
"city": "MODESTO",
"state": "CA",
"postal_code": "953503245",
"telephone_number": "209-846-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDEZONA",
"first_name": "EDWINA",
"middle_name": "ATILLO",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-22",
"last_updated": "2014-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 25591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.