Provider Demographics
NPI:1205401981
Name:MILBRANDT, MARK DAVID (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:MILBRANDT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36560 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50424-7637
Mailing Address - Country:US
Mailing Address - Phone:641-903-6411
Mailing Address - Fax:
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO CENTER
Practice Address - State:IA
Practice Address - Zip Code:50424-7731
Practice Address - Country:US
Practice Address - Phone:641-562-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist