Provider Demographics
NPI:1235869934
Name:MANTHEI, MARK DANIEL
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DANIEL
Last Name:MANTHEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 CLAYTON RD # 403
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1602
Mailing Address - Country:US
Mailing Address - Phone:636-226-4159
Mailing Address - Fax:
Practice Address - Street 1:11 OHRAZDA LN
Practice Address - Street 2:
Practice Address - City:EAST WENNATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802
Practice Address - Country:US
Practice Address - Phone:636-226-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic