Provider Demographics
NPI:1659010015
Name:HURTADO OCAMPO, ANDREA (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HURTADO OCAMPO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3759
Mailing Address - Country:US
Mailing Address - Phone:614-537-6460
Mailing Address - Fax:
Practice Address - Street 1:6021 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2256
Practice Address - Country:US
Practice Address - Phone:614-895-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist