Provider Demographics
NPI:1437694999
Name:MENSEN, BRAD (DPT, ATC/L, CSCS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:MENSEN
Suffix:
Gender:M
Credentials:DPT, ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 29TH AVE
Mailing Address - Street 2:140
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 29TH AVE
Practice Address - Street 2:140
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1108
Practice Address - Country:US
Practice Address - Phone:319-200-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0780662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic