Basic Information
| Provider Information | |||||||||
| NPI: | 1093745762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE PHYSICAL THERAPY OF STARK COUNTY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80097 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447080097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407776017 | ||||||||
| FaxNumber: | 4407776940 | ||||||||
| Practice Location | |||||||||
| Address1: | 3625 TUSCARAWAS ST W | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447085642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304569977 | ||||||||
| FaxNumber: | 3304569979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KRUPAR | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3304569977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.