Provider Demographics
NPI:1427382696
Name:DREES, MANDI JO (ATC)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:JO
Last Name:DREES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 24TH ST NW
Mailing Address - Street 2:APT 9
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-1829
Mailing Address - Country:US
Mailing Address - Phone:712-830-8398
Mailing Address - Fax:
Practice Address - Street 1:313 24TH ST NW
Practice Address - Street 2:APT 9
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-1829
Practice Address - Country:US
Practice Address - Phone:712-830-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0508023302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer