Provider Demographics
NPI:1891857165
Name:EHLERS, MANDI ELAINE (MSPT)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:ELAINE
Last Name:EHLERS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:ELAINE
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 HALLER ST
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7440
Mailing Address - Country:US
Mailing Address - Phone:907-444-0682
Mailing Address - Fax:
Practice Address - Street 1:108 E CORRAL AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7524
Practice Address - Country:US
Practice Address - Phone:907-260-5893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist