Provider Demographics
NPI:1467461509
Name:HOLZBACHER, JON A (PT)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:A
Last Name:HOLZBACHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-7778
Practice Address - Street 1:6480 HARRISON AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-354-7778
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-010266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000483072OtherANTHEM
OHP00331815OtherMEDICARE RAILROAD
OH415572OtherWELLCARE
OH2682913Medicaid
OHHO4188431Medicare PIN