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NPI Code Detail

MEDICARE: MR. BRYAN VANDEHEY

MEDICARE: MR. BRYAN VANDEHEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1791-19WI

General Provider Information

NPI Number : 1669768412
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN VANDEHEY
Provider Business Mailing Address
First Line : 761 POWERS ST
Second Line :
City : OSHKOSH
State : WI
Zip : 54901-4656
Country : US
Telephone Number : 920-216-8854
Fax Number :
Provider Business Practice Location Address
First Line : 1226 BERLIN ST
Second Line :
City : WAUPACA
State : WI
Zip : 54981-1991
Country : US
Telephone Number : 715-258-5521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2011
Last Update Date : 06/21/2011

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Directions to “ MR. BRYAN VANDEHEY ” Practice Location

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