Healthcare Provider Details

I. General information

NPI: 1164635298
Provider Name (Legal Business Name): ANGELA JUSTINA BEISNER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2491 OLENTANGY RIVER RD
COLUMBUS OH
43210-1031
US

IV. Provider business mailing address

2458 CRYSTAL SPRINGS DR
HILLIARD OH
43026-6905
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-7860
  • Fax: 614-292-3258
Mailing address:
  • Phone: 614-529-0592
  • Fax: 614-292-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-1577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: