Provider Demographics
NPI:1376535781
Name:PROGRESSIVE HEALTH AND REHAB CORP
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH AND REHAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:YANNESSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-471-5442
Mailing Address - Street 1:358 S HAMILTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3311
Mailing Address - Country:US
Mailing Address - Phone:614-471-5442
Mailing Address - Fax:614-471-5462
Practice Address - Street 1:358 S HAMILTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3311
Practice Address - Country:US
Practice Address - Phone:614-471-5442
Practice Address - Fax:614-471-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2080111NN0400X
OH340045652081P2900X
OHPT10430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9332191Medicare ID - Type Unspecified