Provider Demographics
NPI:1043261233
Name:PROGRESSIVE PHYSICAL THERAPY SERVICE INC.
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-743-8700
Mailing Address - Street 1:17751 MURDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1034
Mailing Address - Country:US
Mailing Address - Phone:941-743-8700
Mailing Address - Fax:941-743-8850
Practice Address - Street 1:17751 MURDOCK CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1034
Practice Address - Country:US
Practice Address - Phone:941-743-8700
Practice Address - Fax:941-743-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY911KOtherBC/BS
FLK1699Medicare ID - Type Unspecified