Provider Demographics
NPI:1215686704
Name:ROEHLIG, SCHANELLE KRYSTAL
Entity type:Individual
Prefix:
First Name:SCHANELLE
Middle Name:KRYSTAL
Last Name:ROEHLIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SCHANELLE
Other - Middle Name:KRYSTAL
Other - Last Name:GRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6472 PORTAGE PATH CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9584
Mailing Address - Country:US
Mailing Address - Phone:440-554-1947
Mailing Address - Fax:
Practice Address - Street 1:2340 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2602
Practice Address - Country:US
Practice Address - Phone:614-416-6132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA010293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant