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General NPI Number Information
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NPI Number | 1851601033
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE THERAPY ASSOCIATES INC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 750 E MAIN ST
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City | CANTON
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State | GA
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Zip | 30114-2808
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Country | US
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Telephone | 404-232-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 CANTON HILLS CIR
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City | MARIETTA
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State | GA
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Zip | 30062-4612
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Country | US
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Telephone | 404-232-0300
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Fax |
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Authorized Official
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Title or Position | CFO OWNER
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Name | MR. JOSEPH P PICKAVANCE
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Credential |
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Telephone | 404-232-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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