Provider Demographics
NPI:1558343814
Name:ANGELINE, JEFFREY ALAN (PT, AT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:ANGELINE
Suffix:
Gender:M
Credentials:PT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 WOLFPEN PLEASANT HILL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-3078
Mailing Address - Country:US
Mailing Address - Phone:513-575-7878
Mailing Address - Fax:513-965-0047
Practice Address - Street 1:5914 WOLFPEN PLEASANT HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-3078
Practice Address - Country:US
Practice Address - Phone:513-575-7878
Practice Address - Fax:513-965-0047
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT06599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH21493ZOtherANTHEM
OH2455801Medicaid
OH2455801Medicaid