Provider Demographics
NPI:1104041060
Name:PROGRESSIVE THERAPY ALTERNATIVES, INC
Entity type:Organization
Organization Name:PROGRESSIVE THERAPY ALTERNATIVES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-866-5196
Mailing Address - Street 1:1560 HENTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1371
Mailing Address - Country:US
Mailing Address - Phone:419-866-5275
Mailing Address - Fax:419-866-5663
Practice Address - Street 1:113 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-1124
Practice Address - Country:US
Practice Address - Phone:419-257-9070
Practice Address - Fax:419-257-0501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE THERAPY ALTERNATIVES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05531AOtherPARAMOUNT
23-2804807OtherRPN
OH0392980Medicaid
OH1609899061OtherCORP NPI NUMBER