Healthcare Provider Details

I. General information

NPI: 1104038678
Provider Name (Legal Business Name): ANGELA KRISTINE KEIR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 STELZER RD
COLUMBUS OH
43219-3129
US

IV. Provider business mailing address

368 POTAWATOMI DR
WESTERVILLE OH
43081-2338
US

V. Phone/Fax

Practice location:
  • Phone: 614-416-6200
  • Fax:
Mailing address:
  • Phone: 614-882-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-4172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: