Provider Demographics
NPI:1083091631
Name:PROGRESSIVE PHYSICAL THERAPY PLUS
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY PLUS
Other - Org Name:PROGRESSIVE PHYSICAL THERAPY AND REHABILITATION INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-547-1140
Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 603
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1920
Mailing Address - Country:US
Mailing Address - Phone:714-643-9012
Mailing Address - Fax:714-643-9015
Practice Address - Street 1:12665 GARDEN GROVE BLVD STE 603
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1920
Practice Address - Country:US
Practice Address - Phone:714-643-9012
Practice Address - Fax:714-643-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty