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General NPI Number Information
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NPI Number | 1104041060
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE THERAPY ALTERNATIVES, INC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 113 N MAIN ST
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City | NORTH BALTIMORE
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State | OH
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Zip | 45872-1124
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Country | US
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Telephone | 419-257-9070
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Fax | 419-257-0501
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Provider Business Mailing Address
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Address Line | 1560 HENTHORNE DR
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City | MAUMEE
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State | OH
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Zip | 43537-1371
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Country | US
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Telephone | 419-866-5275
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Fax | 419-866-5663
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DAWN MARIE TOLIVER
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Credential |
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Telephone | 419-866-5196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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