Provider Demographics
NPI:1922244870
Name:PRO PT, INC.
Entity Type:Organization
Organization Name:PRO PT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TOSCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-850-8909
Mailing Address - Street 1:2846 EBERLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4402
Mailing Address - Country:US
Mailing Address - Phone:541-850-8909
Mailing Address - Fax:541-882-4005
Practice Address - Street 1:2846 EBERLEIN AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4402
Practice Address - Country:US
Practice Address - Phone:541-850-8909
Practice Address - Fax:541-882-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty