Healthcare Provider Details

I. General information

NPI: 1861716862
Provider Name (Legal Business Name): ANDREA VONNETZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 HIGH ST
WORTHINGTON OH
43085-4109
US

IV. Provider business mailing address

3107 OAKLAWN ST
COLUMBUS OH
43224-4356
US

V. Phone/Fax

Practice location:
  • Phone: 614-847-1100
  • Fax: 614-847-9200
Mailing address:
  • Phone: 614-261-6587
  • Fax: 614-847-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.014705
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: