Provider Demographics
NPI:1376681221
Name:PROGRESSIVE REHAB, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREISDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:JENELL
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:270-688-8559
Mailing Address - Street 1:1605 SCHERM RD STE 1
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5300
Mailing Address - Country:US
Mailing Address - Phone:270-685-9499
Mailing Address - Fax:270-852-5277
Practice Address - Street 1:1605 SCHERM RD STE 1
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5300
Practice Address - Country:US
Practice Address - Phone:270-685-9499
Practice Address - Fax:270-852-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN257250Medicare PIN