Healthcare Provider Details

I. General information

NPI: 1104041060
Provider Name (Legal Business Name): PROGRESSIVE THERAPY ALTERNATIVES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N MAIN ST
NORTH BALTIMORE OH
45872-1124
US

IV. Provider business mailing address

1560 HENTHORNE DR
MAUMEE OH
43537-1371
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-9070
  • Fax: 419-257-0501
Mailing address:
  • Phone: 419-866-5275
  • Fax: 419-866-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAWN MARIE TOLIVER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 419-866-5196