Provider Demographics
NPI:1912906504
Name:TODHUNTER, SALLY ANN (MHS,PT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:TODHUNTER
Suffix:
Gender:F
Credentials:MHS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3425
Mailing Address - Country:US
Mailing Address - Phone:614-566-3444
Mailing Address - Fax:614-566-3895
Practice Address - Street 1:3773 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3425
Practice Address - Country:US
Practice Address - Phone:614-566-3444
Practice Address - Fax:614-566-3895
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2019-07-01
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
OHPT08531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551582Medicaid
OHDA4149171Medicare ID - Type Unspecified