Healthcare Provider Details

I. General information

NPI: 1508265091
Provider Name (Legal Business Name): ABBY RAE REZANSOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY RAE BANDY PT

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 S ANKENY BLVD BUILDING 6
ANKENY IA
50023-8995
US

IV. Provider business mailing address

1200 PLEASANT ST SOUTH 2 ROOM 236
DES MOINES IA
50309-1406
US

V. Phone/Fax

Practice location:
  • Phone: 515-289-9541
  • Fax: 515-446-3642
Mailing address:
  • Phone: 515-241-6228
  • Fax: 515-241-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4260
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number082377
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: