Provider Demographics
NPI:1548509938
Name:MENTZ, BOBBIE JO (MPT)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE JO
Middle Name:
Last Name:MENTZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 JULINGTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2727
Mailing Address - Country:US
Mailing Address - Phone:904-288-9301
Mailing Address - Fax:
Practice Address - Street 1:3159 JULINGTON CREEK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2727
Practice Address - Country:US
Practice Address - Phone:904-288-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist