Individual
EMBER GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
150 W MAIN ST, NEW ALBANY, OH 43054-9229
(614) 685-9425
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2639
(614) 722-2200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
12832
OH
2251P0200X
Pediatric Physical Therapist
Primary
PT12832
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0282965
—
OH
Enumeration date
03/20/2014
Last updated
04/09/2025
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