Provider Demographics
NPI:1558466185
Name:FANDEL, ASHLEE ERIN (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:ERIN
Last Name:FANDEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLLINS RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52498-0505
Mailing Address - Country:US
Mailing Address - Phone:319-295-8899
Mailing Address - Fax:319-295-8833
Practice Address - Street 1:400 COLLINS RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52498-0505
Practice Address - Country:US
Practice Address - Phone:319-295-8899
Practice Address - Fax:319-295-8833
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA031112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IAIB1212017Medicare PIN
IAI19172Medicare PIN
IAIB1213008Medicare PIN
IAIB1212Medicare PIN
IA0665430Medicaid
IAI19172047Medicare PIN