Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 PARK AVE E
MANSFIELD OH
44905-2860
US

IV. Provider business mailing address

812 PARK AVE E
MANSFIELD OH
44905-2860
US

V. Phone/Fax

Practice location:
  • Phone: 419-589-8819
  • Fax: 419-589-8892
Mailing address:
  • Phone: 419-589-8819
  • Fax: 419-589-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-085417
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-000720
License Number StateOH

VIII. Authorized Official

Name: DR. THEODORE TOGLIATTI
Title or Position: PRESIDENT
Credential: MD
Phone: 419-589-8819