Provider Demographics
NPI:1417906314
Name:PROGRESSIVE THERAPY INC
Entity Type:Organization
Organization Name:PROGRESSIVE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCABEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-575-4212
Mailing Address - Street 1:40 MEADOW LANE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-2656
Mailing Address - Country:US
Mailing Address - Phone:251-575-4212
Mailing Address - Fax:800-848-9837
Practice Address - Street 1:40 MEADOW LANE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-2656
Practice Address - Country:US
Practice Address - Phone:251-575-4212
Practice Address - Fax:800-848-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009504700Medicaid
AL51050310OtherBLUE CROSS BLUE SHIELD
AL51050310OtherBLUE CROSS BLUE SHIELD
=========OtherUNITED MINE WORKERS
0965140001Medicare ID - Type UnspecifiedPALMETTO GBA