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General NPI Number Information
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NPI Number | 1376820662
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Entity Type | Individual
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Provider Name | MANDI ELISE VONDERHAAR PT
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Gender | Female
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 880 KINNEAR RD
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City | COLUMBUS
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State | OH
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Zip | 43212-1443
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Country | US
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Telephone | 330-697-8327
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Fax |
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Provider Business Mailing Address
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Address Line | 67 W DUNEDIN RD
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City | COLUMBUS
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State | OH
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Zip | 43214-4001
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Country | US
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Telephone | 330-697-8327
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Fax | 614-850-0540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 38346
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT.013298
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License Number State | OH
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