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General NPI Number Information
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NPI Number | 1760945281
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Entity Type | Individual
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Provider Name | MRS. JOAN MARIE TOLLE
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 2316 SPRINGMILL RD
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City | DAYTON
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State | OH
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Zip | 45440-2504
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Country | US
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Telephone | 937-439-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 WALNUT GROVE LN
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City | SPRINGFIELD
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State | OH
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Zip | 45504-4355
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Country | US
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Telephone | 937-244-5568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA001115
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License Number State | OH
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