Provider Demographics
NPI:1871871566
Name:WARD, MANDI LYNN (DPT)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 17TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2724
Mailing Address - Country:US
Mailing Address - Phone:712-580-4375
Mailing Address - Fax:
Practice Address - Street 1:20 W 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3906
Practice Address - Country:US
Practice Address - Phone:712-580-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist