Healthcare Provider Details

I. General information

NPI: 1447447578
Provider Name (Legal Business Name): ANDREA NICOLE WALL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 SCIOTO DARBY RD
HILLIARD OH
43026-1310
US

IV. Provider business mailing address

6036 ROUND TOWER LN
DUBLIN OH
43017-3451
US

V. Phone/Fax

Practice location:
  • Phone: 614-876-7356
  • Fax: 614-529-7121
Mailing address:
  • Phone: 614-932-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number11185
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11185
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: