Provider Demographics
NPI:1205180189
Name:HONNOLD, BARBARA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:HONNOLD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-6421
Mailing Address - Country:US
Mailing Address - Phone:937-399-0242
Mailing Address - Fax:
Practice Address - Street 1:2150 MONTEGO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-6464
Practice Address - Country:US
Practice Address - Phone:937-390-9913
Practice Address - Fax:937-346-0410
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05577225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant