Provider Demographics
NPI:1356456057
Name:PROGRESSIVE THERAPEUTICS, PC
Entity Type:Organization
Organization Name:PROGRESSIVE THERAPEUTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT.
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SHIKH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:708-623-4222
Mailing Address - Street 1:16610 S. 107TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8898
Mailing Address - Country:US
Mailing Address - Phone:708-364-7500
Mailing Address - Fax:708-364-7555
Practice Address - Street 1:16610 S. 107TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8898
Practice Address - Country:US
Practice Address - Phone:708-364-7500
Practice Address - Fax:708-364-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN53000087A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201070OtherMEDICARE PTAN
ILIL5301OtherMEDICARE PTAN