Basic Information
| Provider Information | |||||||||
| NPI: | 1558487942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAIORANO | ||||||||
| FirstName: | ABBY | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 BALDWIN HILLS DR | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453223510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378368916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 KING TREE DR | ||||||||
| Address2: | RIVERSIDE NURSING AND REHABILITATION | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454051401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372780723 | ||||||||
| FaxNumber: | 9372768280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA05320 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.