Provider Demographics
NPI:1427189760
Name:DURCHHOLZ, ANGELA GISELA (PT, MS)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GISELA
Last Name:DURCHHOLZ
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 NEALE LN
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9493
Mailing Address - Country:US
Mailing Address - Phone:513-774-7900
Mailing Address - Fax:513-774-7999
Practice Address - Street 1:732 MIDDLETON WAY
Practice Address - Street 2:STE. 102
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6989
Practice Address - Country:US
Practice Address - Phone:513-774-7900
Practice Address - Fax:513-774-7999
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 005243225100000X
OHPT.005243261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2627205Medicaid
OH2627205Medicaid