Provider Demographics
NPI:1972850279
Name:ONYEKANNE, ANGELA DEMETRIA (DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DEMETRIA
Last Name:ONYEKANNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:123 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4263
Mailing Address - Country:US
Mailing Address - Phone:513-799-8263
Mailing Address - Fax:
Practice Address - Street 1:123 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:OH
Practice Address - Zip Code:45215-4263
Practice Address - Country:US
Practice Address - Phone:513-799-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH017759225100000X
VA2305205116225100000X
MD24715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist