Provider Demographics
NPI:1780073544
Name:MOHR, ANDREW ROBERT (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:MOHR
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1057
Mailing Address - Country:US
Mailing Address - Phone:712-256-6556
Mailing Address - Fax:
Practice Address - Street 1:2700 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1057
Practice Address - Country:US
Practice Address - Phone:712-256-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0009812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer