Provider Demographics
NPI:1306464730
Name:DIMANLIG, MARIA MENDOZA (PT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MENDOZA
Last Name:DIMANLIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA ALEXANDRA
Other - Middle Name:JOCHICO
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 JORDAN PL APT 100-B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 BILLINGSLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1066
Practice Address - Country:US
Practice Address - Phone:704-577-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35688225100000X
NCP22030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist