Provider Demographics
NPI:1093768285
Name:VANDRE, DOREEN KAY (MS, PT, ATC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:KAY
Last Name:VANDRE
Suffix:
Gender:F
Credentials:MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 N 94TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4507
Mailing Address - Country:US
Mailing Address - Phone:414-771-0435
Mailing Address - Fax:
Practice Address - Street 1:10950 W. CAPITOL DRIVE
Practice Address - Street 2:COULMBIA WEST CLINIC
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-464-4460
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5719-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist