Basic Information
| Provider Information | |||||||||
| NPI: | 1902149990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PT LINK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 MONROE STREET | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195595591 | ||||||||
| FaxNumber: | 8662685006 | ||||||||
| Practice Location | |||||||||
| Address1: | 4210 W. SYLVANIA AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195595591 | ||||||||
| FaxNumber: | 8662685006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | GEORGE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4198431370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10498 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.