Provider Demographics
NPI:1316215304
Name:PROGRESSIVE REHAB, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-636-4266
Mailing Address - Street 1:2373 E BASELINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2477
Mailing Address - Country:US
Mailing Address - Phone:480-497-2642
Mailing Address - Fax:480-497-1863
Practice Address - Street 1:2373 E BASELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2477
Practice Address - Country:US
Practice Address - Phone:480-636-4266
Practice Address - Fax:480-497-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty