Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 120899-2401 | UT |
NPI | 1275682262 |
---|---|
Provider Name | Wendell B Mendenhall |
First Address | Alpine, UT 84004-1972 |
Second Address | Alpine, UT 84004-1557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |