Provider Demographics
NPI:1932978533
Name:VENTURA, MANDI ROBYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:ROBYN
Last Name:VENTURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:MANDI
Other - Middle Name:ROBYN
Other - Last Name:KULBERSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4455 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2504
Mailing Address - Country:US
Mailing Address - Phone:414-427-5310
Mailing Address - Fax:414-427-5311
Practice Address - Street 1:4455 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2504
Practice Address - Country:US
Practice Address - Phone:414-427-5370
Practice Address - Fax:414-307-1853
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14575-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist