Provider Demographics
NPI:1881963353
Name:PROACTIVE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PROACTIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:740-971-8344
Mailing Address - Street 1:11761 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9511
Mailing Address - Country:US
Mailing Address - Phone:740-971-8344
Mailing Address - Fax:740-965-6326
Practice Address - Street 1:580 E BROAD ST
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7570
Practice Address - Country:US
Practice Address - Phone:740-971-8344
Practice Address - Fax:740-965-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7033261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy