Provider Demographics
NPI:1275164121
Name:PROGRESSIVE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY, LLC
Other - Org Name:PHOENIX REHABILITATION AND HEALTH SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-989-4564
Mailing Address - Street 1:PO BOX 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9573
Mailing Address - Country:US
Mailing Address - Phone:724-584-5739
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:416 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4511
Practice Address - Country:US
Practice Address - Phone:703-817-2914
Practice Address - Fax:702-817-2916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-30
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty