Provider Demographics
NPI:1205994456
Name:SHORT, LONDA E (PTA)
Entity type:Individual
Prefix:
First Name:LONDA
Middle Name:E
Last Name:SHORT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LONDA
Other - Middle Name:E
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:367 BUXTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2454
Mailing Address - Country:US
Mailing Address - Phone:937-324-7543
Mailing Address - Fax:
Practice Address - Street 1:367 BUXTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2454
Practice Address - Country:US
Practice Address - Phone:937-324-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT 254077225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant