MEDICARE: HEATHER SKIDMORE NAGEOTTE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	04582	OH

General Provider Information

NPI Number	:	1578761383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SKIDMORE NAGEOTTE PTA

Provider Business Mailing Address
First Line	:	2123 TONDA LN
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3784
Country	:	US
Telephone Number	:	614-648-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	3710 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3450
Country	:	US
Telephone Number	:	614-457-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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