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General NPI Number Information
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NPI Number | 1821552563
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Entity Type | Individual
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Provider Name | ALEXANDRIA VICTORIA KIEHL PTA
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Gender | Female
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 175 CAPE MAY DR
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City | WILMINGTON
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State | OH
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Zip | 45177-2065
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Country | US
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Telephone | 937-382-2995
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Fax |
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Provider Business Mailing Address
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Address Line | 5907 PINE GLEN LN
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City | DAYTON
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State | OH
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Zip | 45424-4473
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Country | US
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Telephone | 937-541-6745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA009582
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License Number State | OH
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