Healthcare Provider Details

I. General information

NPI: 1740362755
Provider Name (Legal Business Name): ADVANCED NEUROLOGIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 STATE ROUTE 113
BELLEVUE OH
44811-9708
US

IV. Provider business mailing address

5433 STATE ROUTE 113
BELLEVUE OH
44811-9708
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-2403
  • Fax: 419-483-8418
Mailing address:
  • Phone: 419-483-2403
  • Fax: 419-483-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAT MCNEA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 419-483-2403