Provider Demographics
NPI:1891428298
Name:FORBIS, MANDI J (LMT)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:J
Last Name:FORBIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W CARTER DR APT 24-204
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7721
Mailing Address - Country:US
Mailing Address - Phone:480-267-0488
Mailing Address - Fax:
Practice Address - Street 1:30 W CARTER DR APT 24-204
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7721
Practice Address - Country:US
Practice Address - Phone:480-267-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-21193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist