Provider Demographics
NPI:1780684290
Name:HUSTON, ANDRIA RENEE (PT)
Entity type:Individual
Prefix:MS
First Name:ANDRIA
Middle Name:RENEE
Last Name:HUSTON
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 1:9419 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6811
Mailing Address - Country:US
Mailing Address - Phone:513-792-0777
Mailing Address - Fax:513-792-0061
Practice Address - Street 1:9419 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6811
Practice Address - Country:US
Practice Address - Phone:513-792-0777
Practice Address - Fax:513-792-0061
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT6094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026880Medicaid
OH2507068Medicaid
OHP00288369OtherMEDICARE RAILROAD
Q21595Medicare UPIN
OH000000322291OtherANTHEM
OH2507068Medicaid