Provider Demographics
NPI:1073740916
Name:PROGRESSUS THERAPY, LLC
Entity Type:Organization
Organization Name:PROGRESSUS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-434-4686
Mailing Address - Street 1:10014 N DALE MABRY HWY STE C-100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4426
Mailing Address - Country:US
Mailing Address - Phone:800-892-0640
Mailing Address - Fax:
Practice Address - Street 1:10014 N DALE MABRY HWY STE C-100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4426
Practice Address - Country:US
Practice Address - Phone:800-892-0640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03288313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility