Healthcare Provider Details

I. General information

NPI: 1750599262
Provider Name (Legal Business Name): AMY CHISNELL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S CLEVELAND AVE
WESTERVILLE OH
43081
US

IV. Provider business mailing address

4204 BENNINGTON CREEK LANE
GROVEPORT OH
43125
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT002780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: