Provider Demographics
NPI:1548246796
Name:KOEHLER, BRANDON A (MPT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:A
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3477 COUNTY ROAD 254
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:OH
Mailing Address - Zip Code:44804-9757
Mailing Address - Country:US
Mailing Address - Phone:419-306-2931
Mailing Address - Fax:
Practice Address - Street 1:3477 COUNTY ROAD 254
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:OH
Practice Address - Zip Code:44804-9757
Practice Address - Country:US
Practice Address - Phone:419-306-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1442035OtherBWC
OH2527699Medicaid
OH1442035OtherBWC