Provider Demographics
NPI:1164635298
Name:BEISNER, ANGELA JUSTINA (ATC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JUSTINA
Last Name:BEISNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2458 CRYSTAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-6905
Mailing Address - Country:US
Mailing Address - Phone:614-529-0592
Mailing Address - Fax:614-292-3258
Practice Address - Street 1:2491 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1031
Practice Address - Country:US
Practice Address - Phone:614-292-7860
Practice Address - Fax:614-292-3258
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-15772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer