Provider Demographics
NPI:1821552563
Name:KIEHL, ALEXANDRIA VICTORIA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:VICTORIA
Last Name:KIEHL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ALEXANDRIA
Other - Middle Name:VICTORIA
Other - Last Name:SHIMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5907 PINE GLEN LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4473
Mailing Address - Country:US
Mailing Address - Phone:937-541-6745
Mailing Address - Fax:
Practice Address - Street 1:175 CAPE MAY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2065
Practice Address - Country:US
Practice Address - Phone:937-382-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA009582225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant