Provider Demographics
NPI:1649071176
Name:VAN DEE, BRANDY M (LMT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:VAN DEE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 200TH ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:IA
Mailing Address - Zip Code:52222-8536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4935 200TH ST
Practice Address - Street 2:
Practice Address - City:DEEP RIVER
Practice Address - State:IA
Practice Address - Zip Code:52222-8536
Practice Address - Country:US
Practice Address - Phone:641-295-4452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist