Provider Demographics
NPI:1346430204
Name:PROGRESSIVE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLESCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-720-1141
Mailing Address - Street 1:1021 S WOLFE RD
Mailing Address - Street 2:#125
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8874
Mailing Address - Country:US
Mailing Address - Phone:408-720-1141
Mailing Address - Fax:
Practice Address - Street 1:1021 S WOLFE RD
Practice Address - Street 2:#125
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-8874
Practice Address - Country:US
Practice Address - Phone:408-720-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT65590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT65590Medicare PIN