MEDICARE: PARK AVE THERAPY AND REHAB, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50-000720	OH
2	208100000X	Physical Medicine & Rehabilitation Physician	35-085417	OH

General Provider Information

NPI Number	:	1851572150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK AVE THERAPY AND REHAB, INC.

Provider Business Mailing Address
First Line	:	812 PARK AVE E
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2860
Country	:	US
Telephone Number	:	419-589-8819
Fax Number	:	419-589-8892

Provider Business Practice Location Address
First Line	:	812 PARK AVE E
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2860
Country	:	US
Telephone Number	:	419-589-8819
Fax Number	:	419-589-8892

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THEODORE TOGLIATTI
Credential	:	MD
Telephone Number	:	419-589-8819

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	01/29/2008

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