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General NPI Number Information
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NPI Number | 1851572150
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Entity Type | Organization
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Legal Business Name | PARK AVE THERAPY AND REHAB, INC.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 812 PARK AVE E
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City | MANSFIELD
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State | OH
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Zip | 44905-2860
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Country | US
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Telephone | 419-589-8819
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Fax | 419-589-8892
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Provider Business Mailing Address
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Address Line | 812 PARK AVE E
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City | MANSFIELD
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State | OH
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Zip | 44905-2860
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Country | US
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Telephone | 419-589-8819
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Fax | 419-589-8892
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE TOGLIATTI
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Credential | MD
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Telephone | 419-589-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50-000720
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35-085417
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License Number State | OH
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