Provider Demographics
NPI:1891162244
Name:MENTZ, MICHAEL R (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MENTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:5592 WHITESVILLE RD STE B1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3400
Practice Address - Country:US
Practice Address - Phone:762-261-3700
Practice Address - Fax:762-744-9001
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015617225100000X
IL070021804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist