Provider Demographics
NPI:1285100321
Name:MENDIOLA, GUNNAR
Entity type:Individual
Prefix:
First Name:GUNNAR
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 SHIPYARD TRCE NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5254
Mailing Address - Country:US
Mailing Address - Phone:478-960-7376
Mailing Address - Fax:
Practice Address - Street 1:3150 N COBB PKWY STE 150
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-1009
Practice Address - Country:US
Practice Address - Phone:678-574-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist