Healthcare Provider Details

I. General information

NPI: 1659010015
Provider Name (Legal Business Name): ANDREA HURTADO OCAMPO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 CLEVELAND AVE
COLUMBUS OH
43231-2256
US

IV. Provider business mailing address

952 WOODHILL DR
GRANDVIEW OH
43212-3759
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-1090
  • Fax:
Mailing address:
  • Phone: 614-537-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019779
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: