Basic Information
| Provider Information | |||||||||
| NPI: | 1093768285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDRE | ||||||||
| FirstName: | DOREEN | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | MS, PT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 N 94TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532224507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147710435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10950 W. CAPITOL DRIVE | ||||||||
| Address2: | COULMBIA WEST CLINIC | ||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144644460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5719-024 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.