Basic Information
| Provider Information | |||||||||
| NPI: | 1730187626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELTNER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | NICHOLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 WESLEY AVE | ||||||||
| Address2: | STE. N | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138415520 | ||||||||
| FaxNumber: | 5138411580 | ||||||||
| Practice Location | |||||||||
| Address1: | 2915 CLIFTON AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452202402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138722000 | ||||||||
| FaxNumber: | 5132818842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-10361 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2513524 | 05 | OH | MEDICAID |