Provider Demographics
NPI:1790959864
Name:PROGRESSIVE THERAPY ALTERNATIVES, INC
Entity Type:Organization
Organization Name:PROGRESSIVE THERAPY ALTERNATIVES, INC
Other - Org Name:ANTHONY WAYNE PHYSICAL THERAPY
Other - Org Type:Doing Business As
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:419-866-5196
Mailing Address - Fax:419-866-5663
Practice Address - Street 1:5907 WECKERLY RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9648
Practice Address - Country:US
Practice Address - Phone:419-877-5144
Practice Address - Fax:419-877-4780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE THERAPY ALTERNATIVES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
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
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1609899061OtherCORPORATE NPI
OH0392980Medicaid
05531AOtherPARAMOUNT
23-2804807OtherRPN